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THE 



PRACTICE OF MEDICINE, 



ACCOHDING TO 



THE PRINCIPLES 



PHYSIOLOGICAL DOCTRINE. 



z 



BY J* COSTER, M. D. 



Medicamenta stomachum fere lsdunt.— Aw. Corn. Cels. lib. II. c. II. 



TRANSLATED FROM THE FRENCH. 



PHILADELPHIA: 
( \ KEY & L.EA. 



1831. 



% 



1 u 



EASTERN DISTRICT OF PENNSYLVANIA, to wit: 

BE IT REMEMBERED, that on the third day of De- 
|k. cember, in the fifty-fifth year of the independence of the 
IS United States of America, A. D. 1830, Caret & Lea of 
SJB^I^Iffi* the said District, have deposited in this office the Title of 

** words following 1 , to wit: 

" The Practice of Medicine, according to the Principles of the Physi- 
ological Doctrine. By J. Coster, M. D. Medicamenta stomachum 
fere lsedunt.— Aur. Corn. Cels. lib. II. c. II. Translated from the 
Trench." 

In conformity to the Act of the Congress of the United States, enti- 
tled, "An Act for the Encouragement of Learning, by securing the 
copies of Maps, Charts, and Books, to the Authors and Proprietors of 
such copies, during the times therein mentioned" — And also to the 
Act, entitled, "An Act supplementary to an Act, entitled, 'An Act 
for the Encouragement of Learning, by securing the copies of Maps, 
Charts and Books, to the Authors and Proprietors of such copies dur- 
ing the times therein mentioned,' and extending the benefits thereof 
to the arts of designing, engraving, and etching Historical and other 
Prints." 

D. CALDWELL, 
Clerk of the Eastern District of Pennsylvania. 



SKEHEETT NINTH STREET, 

PHILADELPHIA. 



INTRODUCTION. 



x Notwithstanding the numerous attacks which phy- 
siological medicine has had to sustain from persons edu- 
cated in the prejudices of an opposite creed, victory has 
declared in its favour, and it has come gloriously through 
the contest. Under its influence the healing art has every 
where undergone incontestible ameliorations, and even 
those who ostensibly are its most determined foes, tacitly 
adopt its principles, and act upon them in their practice. 
This policy, at the same time that it gratifies their self- 
love, subserves the interests of their patients. 

Perhaps the author will be charged with inconsistency, 
as having combated in other writings the doctrine of 
which he here avows himself the partizan. Such a re- 
proach, however, would be totally destitute of foundation, 
since he has always subscribed to the fundamental princi- 
ples of this doctrine, and never entertained any difference 
of sentiment, except upon certain points; but were the 
case otherwise, would it be creditable to cherish the pal- 
try vanity, that withholds the avowal of a change of opi- 
nion, brought about by observation and more mature re- 
flection? The system of immobility in the sciences, and 
especially in the medical sciences, is an absurdity, since 
the object of study is to enlarge the sphere of our know- 
ledge, and to rectify erroneous opinions. No kind of ere- 1 
dit could redound from the obstinate defence of preju- 
dices and errors known to be such. As for myself, while 
I express a high sense of gratitude to the founder of the 
physiological doctrine, for having carried the light of ana- 



IV INTRODUCTION. 

lysis into the midst of so many opposing systems, the 
least inconvenience of which was their tendency to pro- 
duce medical scepticism, I shall say with the same frank- 
ness, that I have no intention of surrendering my inde- 
pendence, and that I shall hold myself at liberty to rp *•»»■ 
or to reject, all new doctrines, and all new lights ... 
might modify my creed. 



CONTENTS. 



Page. 

Phlegmasia or Inflammatory Irritations ... 5 

Irritations and Phlegmasia of the Digestive Tube - 7 

Gastritis ib. 

Fevers called Essential 10 

Acute Gastro-enteritis. The form denominated Bilious Fever ib. 
Acute Gastro-enteritis. The form called Angiotenic, or Inflam- 
matory Fevers, Synochus 12 

Acute Gastro-enteritis. The form called Ardent Fever, Causus 13 

Acute Gastro-enteritis. The form called Mucous Fever - 14 

Acute Gastro-enteritis. The form called Verminous Fever - 15 
Acute Gastro-enteritis. The forms which have been called 

Ataxic Fever, Adynamic Fever, Camp Fever, Yellow Fever 16 
Regimen of Convalescents, after an attack of Gastritis or Gas- 
tro-enteritis 19 

Acute Colitis .---...--- ib. 

Chronic Phlegmasia of the Intestinal Canal 21 

Chronic Gastritis and Gastro-enteritis ib. 

First Shade of Chronic Gastro-enteritis with the form called 
Slow Fever, Slow Nervous Fever, Tabes mesenterica, Atro- 
phia infantalis ib. 

Second Shade of Chronic Gastro-enteritis, with a pain which 

is called Hepatic, Splenic, Phthisical .... 23 
Third Shade of Chronic Gastro-enteritis. — Cynorexia, Boulimia, 

Hypochondriasis 24 

Fourth Shade of Chronic Gastro-enteritis. — Scirrhus and Can- 
cer of the Stomach 26 

Acute Peritonitis 31 

Chronic Peritonitis 34 

Inflammation of the Liver. — Hepatitis, Icterus ... 36 

Chronic Febrile Hepatitis 38 

Chronic Hepatitis, not Febrile 39 

Inflammation of the Spleen. — Splenitis .... 40 

PllLEftMASI/1: (IK THE UllINAIlY APPARATUS, ( KidllCyS aiul Bladder) it. 

Acute Nephritis 41 



VI CONTENTS. 

Page. 

Chronic Nephritis and Nephritic Colic .... 43 

Acute Phlegmasia of the Bladder. — Cystitis ... 46 

Chronic Phlegmasia of the Bladder. — Catarrhus Vesicae - 48 

Sequelae of the affections of the Urinary Apparatus. — Diabetes 50 

Phlegmasia of the Genital Organs ----- 53 

Irritation and Inflammation of the Uterus, Metritis - - ib. 

Sequelae of the Phlegmasiae of the Uterus - 55 

Acute Catarrh of the Uterus ib. 

Chronic Uterine Catarrh, Fluor Albus, Leucorrhoea - - 56 
Sequelae of the Chronic Phlegmasiae of the Uterus, Organic 

Alterations, Scirrhus and Cancer of the Neck of the "Womb 59 
Phlegmasiae of the Body of the Uterus and Ovaria, with Orga- 
nic Alterations of these parts ---_-. 63 
Irritations and Inflammations of the Genital Apparatus of Man 66 

Inflammation of the Urethra ib. 

Treatment of Acute Inflammation of the Urethra — Acute Blen- 

norrhagy 67 

Treatment of Chronic Inflammation of the Urethra— Chronic 

Blennorrhagy -- - 68 

Inflammation of the Testicle; Venereal Testicle. — Organic 

Alterations which result from it 69 

Abdominal Phlegmon -- 72 

Inflammatory Irritations of the Mucous Membrane of the 
Pectoral Viscera and their connexions: — of the Nose, 
the Ear, the Ete, the Mouth, the Velum of the Palate, 

the Tonsils, the Phartnx, &c. 74 

Irritations of the Nasal Mucous Membrane. — Coryza 75 

Phlegmasia of the Organs of Hearing. — Otitis ... 77 

Phlegmasiae of the Organs of Sight. — Ophthalmitis - - 79 

Phlegmasia of the Parietes of the Mouth. — Fluxion - - 83 

Phlegmasia of the Gums. — Gengivitis 84 

Aphthae 85 

Phlegmasiae of the Velum Palati, of the Tonsils, and of the 

Uvula. — Angina Tonsillaris - 87 

Symptoms of Acute Angina Tonsillaris ... - ib. 

Symptoms of Chronic Angina Tonsillaris ... - 88 

Symptoms of Malignant and Gangrenous Angina - - ib. 
Phlegmasia of the Pharynx and OZsophagus. — Angina of the 

Pharynx 92 

Phlegmasiae of the Mucous Membrane of the Air Passages, the 

Larynx, the Trachea, and the Bronchia ... - 93 

Bronchial or Tracheo-bronchial Irritation. — Pulmonary Catarrh ib. 



CONTENTS. VU 

Page. 

Angina Laryngaa, or Laryngeo-trachealis in adults - - 96 

Angina Laryngea of Infants. — Croup 98 

Convulsive Irritation of the Air Passages. — Hooping Cough 101 

Chronic Laryngitis, or Tracheitis 103 

(Edematous Angina - 106 

Phlegmasia of the Pectoral Viscera .... 108 

Acute Pneumonia and Pleuro-pneumonia .... ib. 

Pericarditis 115 

Chronic Forms of Irritation of the Pectoral Viscera - 117 

Chronic Pulmonary Catarrh ib. 

Chronic Pleurisy 119 

Chronic Pericarditis 124 

Chronic Pneumonia. — Phthisis Pulmonalis ... - 125 

Acute and Chronic Cutaneous Phlegmasia. — Exanthemata 135 

Furuncle and Anthrax -------- 137 

Carbuncle, or Pustula Maligna 139 

Paronychia 140 

Erysipelas, Erythema, Zona 141 

Scarlatina, or Scarlet Fever 144 

Measles 146 

Variola, or Small-pox - - 149 

Varicella, or Variola volatica ------ 154 

Miliary Fever -- 155 

Urticaria ---------- 156 

Pemphigus -- 157 

Chronic Phlegmasia and Sub-inflammations of the Skin - 159 

Psora— Itch 160 

Prurigo 162 

Herpetic Affections, Tetter 163 

Tinea 169 

Tricoma, or Plica polonica 171 

Lepra 172 

Induration of the Skin in New-born Infants - 175 

Arthritic and Muscular Phlegmasia ib. 

Simple Arthritis, the Gout or Podagra of Authors - - 177 

Arthritis occupying the Great Articulations, or Rheumatic Gout 181 

Muscular Inflammation, Myositis, Rheumatism - - - 183 

II v.MnnuiiAGF.s, ou Irritations with a Flow of Blood - 187 

V, : ( I I hemorrhage, or Epistaxis 190 

Cerebral Apoplexy, or Hemorrhage of the Brain - - 191 
Hemorrhage of the Lungs, and of the Mucous Membrane of the 

Air Passages, (Pulmonary Apoplexy, Hemoptysis) - - 194 



VIII CONTENTS. 

Page. 

Hemorrhage of the Stomach, (Hematemesis) - - - 197 

Haemorrhage of the Intestinal Canal, (Hementeresis) - - 198 

Uterine Haemorrhage, (Metrorrhagy) 200 

Haemorrhoids 203 

Hemorrhages of the Urinary Passages, (Hematuria) - - 206 

Cutaneous Hemorrhage, (Diapedesis) 208 

Hemorrhage of the Gums 209 

Hemorrhage of the Serous Membranes, (of the Peritoneum and 

of the Pleura) ib. 

Retention, Diminution, or Suppression of Periodical Hemorrhages 211 

Amenorrhcea, or Dysmenorrhea 212 

Definitive Suppression of the Menses 216 

Suppression of the Hemorrhoidal Flux .... 217 

Nervocs Irritations 218 

General View of the Treatment of Nervous Irritations - - 224 
Affections of the Nervous Centres — Irritations of the Brain and its 

Envelopes 227 

Acute Cerebral Irritations — Encephalitis and Arachnitis - 228 

Sub-acute and Chronic Cerebral Irritations .... 231 

Acute Arachnitis of Infants, (Acute Hydrocephalus of Authors) 239 
Continuation of the Affections of the Nervous Centres, (Myelitis 

and Spinal Arachnitis) 243 

Irritations of the Nervous Expansions, (Neurosis and Neuralgia) 247 

Tetanus 251 

Clonic Convulsions 255 

Chorea, or St. Vitus's Dance 257 

The Muscular Tremours of Gilders 259 

Hysteria ib. 

Hypochondriasis 263 

Neuroses of the Organs of Respiration, (Convulsive Asthma) 264 

Incubus, or Nightmare 266 

Neuroses of the Heart, (Palpitation) 267 

Angina Pectoris 269 

Hypertrophy and Aneurism of the Heart .... 272 

White, or Lymphatic Irritations 276 

Varieties of the Scrofulous Affection 281 

Periodical Irritations, (Intermittent Fevers) .... 291 

Dropsies 300 

Scorbutus • 307 

Syphilis 310 

Intestinal Worms - - 314 



THE 

PRACTICE OF MEDICINES, 

ACCORDING TO THE PRINCIPLES OP THE 

PHYSIOLOGICAL DOCTRINE. 



PHLEGMASIA,. 



INFLAMMATORY IRRITATIONS. 

External inflammation is generally accompanied by 
four principal circumstances, which characterize phleg- 
mon, pain, swelling, heat, and redness. 

Internal has its type in external inflammation. 

The absence, however, of some of these circumstances 
is compatible with the existence of irritation. 

By irritation is understood an increased activity of the 
part in which it is seated. When this irritation is intense, 
it creates disorders in remote parts of the system, provid- 
ed the seat of this irritation be not a tissue endowed with 
little sensibility, and possessed of few sympathies with 
other organs. These disorders are of various kinds, but 
the derangement of most frequent occurrence under the 
influence of an irritation or an inflammation, is fever. 

Fever never exists but as one of the symptoms of a lo- 
cal inflammation, either internal or external. A whitlow, 
a boil, an ophthalmia, an angina, and other external phleg- 
masia! often produce fever as well as pneumonia, metri- 
tis, &c. ; yet fever has been considered only an accessory 
symptom of these topical phlegmasia?. 
2 



6 THE PHYSIOLOGICAL 

Authors, however, have made fever a malady stii ge- 
neris, in other words an essential disease, whenever they 
have lost sight of the seat of the inflammation which had 
given rise to this symptom. 

Yet analogy would have led to the presumption that 
these fevers had been produced by the same causes as the 
preceding — that is, by a local irritation. The problem to 
be solved then was to discover the seat of the fevers cal- 
led essential. It has been discovered that this seat is the 
mucous membrane of the intestinal canal, particularly of 
the stomach and smaller intestines. The truth of this pro- 
position has been placed beyond contradiction by dissec- 
tion. 

When patients fall victims to fevers called essential, 
which we shall henceforth call gastrites, or gastro-ente- 
rites, the intestinal canal always presents traces of phleg- 
masia. 

Fever produced by irritation of the mucous membrane 
of the intestinal canal, may assume a thousand different 
shades, so that it may be difficult to meet with cases of 
precisely the same character in two individuals. But 
these diversities of forms or of shades are not indicative 
of a difference in the nature of the affections; they are 
only the result of the degree of the phlegmasia, which 
awakens sympathies varying in number with the age, the 
constitution, and the irritability of the subject. 

Authors have given different names to these shades of 
fever, and made them so many distinct diseases, having 
been accustomed to give the name of disease to a certain 
group of symptoms: thus, there were inflammatory, 
bilious, mucous, malignant, adynamic, and ataxic fevers, 
&c. ; now, these fevers are nothing but gastrites and gas- 
tro-enterites of different degrees in subjects of the san- 
guine, lymphatic, bilious, or nervous temperament. 

As external phlegmasia almost always exert an influ- 



PRACTICE OF MEDICINE. 7 

ence more or less powerful over the mucous surface of 
the stomach, and as the stomach and intestinal tube pos- 
sess sympathies with most of the other viscera, and with 
different parts of the body, so that irritations of the intes- 
tinal mucous membrane can hardly exist without giving 
rise to derangement, more or less marked, of a great num- 
ber of functions, it is natural to commence the history of 
the phlegmasia? with those of the intestinal canal. 

t 

IRRITATIONS AND PHLEGMASIA OF THE DIGESTIVE TUBE. 

GASTRITIS. 

Of the different membranes of which the intestinal tube 
is composed, the mucous is most susceptible of inflamma- 
tion. 

This organ is the seat of a very delicate sense, whose 
office it is to announce hunger and thirst, and to secrete a 
juice necessary for digestion. It readily influences other 
organs, and in its turn is easily influenced by them. 

That the mucous membrane of the stomach and bowels 
is the most frequent seat of irritation, is an incontestible 
fact, which may be readily accounted for from the nu- 
merous causes which act upon this membrane. It is ex- 
cited — 

1st. By hunger and thirst. 

2d. By ingesta of every kind. 

3d. By mechanical agents, blows, contusions, &c. 

4th. By emanations transmitted by the air. 

5th. By the circumfusa, cold, heat, humidity, light, 
electricity. 

6th. By the moral affections. 

Symptoms of Gastritis. 
Sometimes it is slow in its commencement, and after- 



8 THE PHYSIOLOGICAL 

wards makes sudden and rapid progress. This most fre- 
quently happens when it supervenes on an old irritation. 
At other times it manifests at its commencement all the 
symptoms about to be enumerated. 

The patient complains at first of general malaise, of 
cold, fatigue, and pains in the head. When there are 
rigors, they are felt particularly along the back and limbs. 

Sometimes there are pandiculations at the moment of 
the accession of the disease. If the irritation increases, 
the epigastric region becomes sensible upon pressure, and 
sometimes without pressure; there is a sensation of burn- 
ing about this region, thirst more or less intense, and a 
desire for cooling drinks. When the disease is of a higher 
grade the pains are more intense, the patient vomits, de- 
glutition becomes difficult, and at this period the irritation 
has arrived at the degree which constitutes inflammation. 

The pain does not always correspond to the region of 
the stomach, but is sometimes referred to that of the liver 
or spleen, or to some point of the thorax, &c. 

The organic sympathies manifest themselves by red- 
ness of the tongue, especially at its point. The mouth, 
as well as all the openings of the mucous membranes, is 
dry; the velum palati is red; the conjunctiva is inflamed; 
the skin partakes of the state of the mucous membranes, 
it is dry and burning; sometimes it is slightly moist; this, 
however, is only at the commencement of the disease, or 
when it is complicated with catarrh or pneumonia. There 
is an increased secretion of bile and of the pancreatic 
juice; an afflux of fluids towards the irritated parts, so 
that the alvine discharges cease. 

Sympathies of Relation. — Pains in different parts of 
the trunk, in the muscles, in the articulations; head-ache 
principally about the supra-orbital and temporal region, 
and about the back part of the head; delirium; wild and 
incoherent dreams; lesion of the functions of the senses 



PRACTICE OP MEDICINE. y 

according to the degree of the disease and the irritability 
of the individual. 

Causes. 
All stimulating ingesta, as alcoholic drinks, aromatic 
substances, those of difficult digestion, irritants, medicines, 
poisons, hunger, thirst, sudden changes of temperature, 
external irritation repeated by sympathy in the mucous 
membrane of the stomach, the metastasis of another irri- 
tation to this organ; a slow irritation which has existed 
for some time, perhaps unsuspected by the patient; fa- 
tigue, moral affections of a violent character, such as 
anger, excess of joy or grief, deep and abiding melancholy. 
All these causes act with an energy modified by the tem- 
perament, the predisposition, and the degree of sensibility 
of the individual. 

Prognosis. 
Gastritis supervening upon a slow and ancient irrita- 
tion, is more dangerous than that which develops itself 
in a subject that has hitherto enjoyed an immunity from 
the disease. If no alteration of structure has taken place 
in the tissues, the prognosis is more favourable. Nature 
sometimes dissipates the disease by means of a crisis, but 
this rarely occurs; the disease generally yields with fa- 
cility to treatment. Violent pain may supervene, ac- 
companied with horrid convulsions, and continual vo- 
miting; this is what authors have denominated cholera 
morbus. It is the highest degree of gastro-enteritis; at 
this stage it is dangerous. 

Treatment. 
Water is sometimes too stimulating, and is rejected by 
the stomach, but this does not occur unless the disease 
has reached a high degree of intensity. Rigid absti- 



10 THE PHYSIOLOGICAL 

nence. If the stomach rejects drinks, they should be 
administered in small spoonfuls. We commence with 
drinks of the most emollient nature, such as gum water, 
that of mallows, lemonade, orangeade, &c. We apply 
leeches to the epigastric region; the quantity of blood 
abstracted must be regulated by the age and strength of 
the subject, and by the intensity of the irritation. The 
number of leeches should vary from fifteen to eighty, and 
upwards. The bites of the leeches should be covered by 
an emollient cataplasm, the removal of which must not 
be neglected, should its weight prove oppressive. Should 
the irritation not be allayed, we recur without hesitation, 
to a second or third application of leeches. In proportion 
as the disease abates in intensity, the choice of drinks is 
less restricted, but those which contain alcohol, aroma- 
tics, or any stimulating article, are never admissible. 
The least imprudence in this respect may cause a relapse. 

FEVERS CALLED ESSENTIAL. 

ACUTE GASTRO-ENTERITIS. 

THE FORM DENOMINATED BILIOUS FEVER. 

Symptoms. 

It often happens that the irritation, after having pre- 
dominated for some days in the upper portion of the in- 
testinal tube, invades its lower part. If this irritation 
confines itself to the stomach or smaller intestines, it is 
gastro-enteritis, (the fever of authors.) It may also first 
assail the small intestine, and advance to the superior 
portion of the canal; or it may manifest itself simulta- 
neously in the two parts. 

The pulse is more frequent, and more developed than 
in gastritis; there is burning heat, thirst, and debility. 
The tongue is red, and covered with a yellowish coat. 



PRACTICE OF MEDICINE. 11 

The patient has a great desire for acidulated drinks. The 
skin, which is at first dry, becomes covered with perspi- 
ration, the secretion of bile is increased. The yellow co- 
lour of the mucous membranes, and this superabundance 
of bile have occasioned the name of bilious fever to be 
given to this form of disease. There is no lesion of the 
cerebral functions; pressure does not occasion pain, pro- 
vided the inflammation has not reached a high degree of 
intensity. The absence of diarrhoea is a proof that the 
irritation has not arrived at the colon. This form of in- 
flammation presents many shades which it is not necessary 
to enumerate. 

Causes. 
The same as those of gastritis. This form of gastro- 
enteritis presents itself more frequently in autumn than 
in any other season. 

Prognosis. 
When the disease is mild, it terminates in three or four 
days; when more intense, it may continue twenty days, 
and even longer. It is dissipated by copious sweats or 
abundant alvine evacuations, or without any critical eva- 
cuation. In general this disease is attended with little 
danger, if the irritation is not increased by a disturbing 
and exciting treatment. 

Treatment. 
Emetics, which routine practitioners have been in the 
habit of employing, under the pretext of evacuating the 
bile, arc to be discarded, and as we know that the bile is 
only an effect of the irritation, we resort to means calcu- 
lated to allay it, and as a consequence the excessive secre- 
tion of bile will cease. If the disease advances, leeches 
are to be applied to the epigastric and umbilical region; 
absolute rest should be enjoined. 



12 THE PHYSIOLOGICAL 

ACUTE GASTRO-ENTERITIS. 

THE FORM CALLED ANGIOTENIC, OR INFLAMMATORY 
FEVERS, SYNOCHUS. 

The symptoms are the same as those of the preceding 
form, except that the tongue is redder, the complexion 
of a deeper colour, and the secretion of bile less abun- 
dant. It is absolutely the same affection, but in a sanguine 
and vigorous subject, without bilious vomiting, and with- 
out the yellow colour. 

Causes. 
All the ordinary causes of gastritis and gastro-enteritis. 
Persons of the sanguine temperament, whose health is or- 
dinarily vigorous, are more exposed to it than any other 
class of individuals. 

Prog)iosis. 
It is easily arrested, if it is attacked at its commence- 
ment, particularly in a subject assailed by it for the first 
time. It is more dangerous if it supervenes upon an old 
gastro-enteritic irritation. If we permit it to advance, it 
may rise to the stage called adynamic fever, and prove 
fatal. 

Treatment' 
Rest, abstinence, mild drinks, acidulated, if there be 
no complication of pneumonia; this exception to the use 
of acidulated drinks extends to all cases in which the com- 
plication of pneumonia exists, as acids have been observed 
to provoke coughing in these cases. The drinks should 
be water sweetened with sugar, and ptisan of gum, with 
the addition of a few drops of sulphuric or citric acid. 
Leeches to the epigastric and umbilical region, which are 



PRACTICE OP MEDICINE. 13 

to be repeated if one application does not prove sufficient 
to arrest the progress of the disease. Emollient injec- 
tions. 

ACUTE GASTRO-ENTERITIS. 

THE FORM CALLED ARDENT FEVER, CAUSUS. 

Symptoms. 
The pains are more violent than in the preceding case, 
the heat is very intense, the thirst unquenchable, and the 
pulse exceedingly quick; a violent head-ache accompanies 
these symptoms, the patient is delirious and tries to escape 
from the bed. There is obstinate costiveness, and the 
urine is high-coloured. If the alimentary canal be sti- 
mulated, the tongue becomes black and dry. From this 
group of symptoms, the present form has derived the name 
of ardent fever, which authors have also considered as an 
essential fever. It has likewise been called causus. 

Causes. 
The same as those of the form called angiotenic. The 
heats of summer contribute powerfully to its production. 

Prognosis. 

If the patient does not labour under an old gastritis, if 
his constitution is sound, if the treatment is not of the in- 
cendiary kind, and the disease is still in its incipient 
stage, it may be overcome; but if the contrary is the case, 
it may justly excite apprehension. 

Treatment. 
Abstinence; the patient should occupy a cool chamber; 
local depletion by means of leeches applied to the abdo- 
men; the application of leeches should be preceded by ve- 
nesection if the pulse is strong, hard, and wirey; emollient 



14 THE PHYSIOLOGICAL 

drinks mixed with syrup, or acidulated with sulphuric 
acid, in the proportion of a few drops to a pint; cold and 
acidulated applications to the abdomen, if there is no com- 
plication of pulmonary irritation, a case in which cold and 
acids are always contra-indicated. If there be cerebral 
irritation, cold applications to the head, which should 
be continued for a long time; acidulated and emollient in- 
jections; the warm bath. 

ACUTE GASTRO-ENTERITIS. 

THE FORM CALLED MUCOUS FEVER. 

Symptoms. 

We have here the same irritation as in the preceding 
cases, but in a subject of a lymphatic or mucous tempera- 
ment, in whom the digestive organs are possessed of little 
activity. If to the ordinary symptoms of gastro-enteritis be 
added an inflammation of some of the other mucous mem- 
branes, as that of the lungs or the bladder, it will consti- 
tute the mucous fever of authors. There is anorexia, an 
incapacity to digest, redness of the tongue; aphthse often 
appear in the mouth, in the pharynx, and in other parts ; 
there is occasionally a complication of dysentery, obtuse 
pains in the limbs, and occasionally in the articulations. 

The predisposing causes are the lymphatic tempera- 
ment, or those constitutions which are remarkable for a 
kind of nonchalance in the movements, and for slight 
consistency of tissue. A hot and dry temperature, food 
of an unwholesome kind or deficient in quantity, and the 
exclusive use of watery drinks, are the most ordinary 
causes of this disease in subjects predisposed. 

Prognosis. 
As this form of gastro-enteritis ordinarily announces a 
lower degree of irritation, it is rarely dangerous. The 



PRACTICE OP MEDICINE. 15 

danger is in proportion to the activity of the irritation, 
and of the other affections which may complicate the 
disease. 

Treatment. 
The abstraction of blood is less urgently demanded in 
this than in the preceding cases; still if the irritation ad- 
vances with rapidity, leeches should be applied to the epi- 
gastric region. If there is a complication of catarrh, 
we apply leeches along the course of the trachea and upon 
the painful points of the thorax. In case of the existence 
of diarrhoea, they should be applied on the verge of the 
anus. Emollient drinks, which may be acidulated if there 
are no catarrhal symptoms. If the irritation is not of 
great intensity, we may prepare the drinks with the gra- 
mm^as, but we must beware of using the latter if the thirst 
be excessive and the tongue very red; aromatics, tonics, 
and broths are out of the question. Sinapisms and blisters 
may be resorted to when irritation has been subdued by 
the antiphlogistic treatment. 

ACUTE GASTRO-ENTERITIS. 

THE PORM CALLED VERMINOUS FEVER. 

Symptoms. 
To the ordinary symptoms of gastro-enteritis are su- 
peradded those which announce the presence of worms, 
a sense of titillation in the fauces, at the end of the 
nose, and at the anus, a strong breath of a sour odour, 
dilatation of the pupil, sometimes a gnawing pain about 
the part occupied by the worms. In individuals of great 
irritability convulsions occur, accompanied by excessive 
pains in the abdomen. 



16 THE PHYSIOLOGICAL 

Causes. 
Bad food, an exsanguious constitution, want of clean- 
liness, and the period of infancy, are the causes which 
ordinarily give a predisposition to worms. The most fre- 
quent cause is inflammation of the intestinal canal, which 
is peculiarly favourable to their existence. Worms may, 
however, precede inflammation, and be the cause of it. 

Prognosis. 
It is rarely a very troublesome disease, provided the 
irritation is not of old standing, and the worms have not 
perforated the alimentary canal. 

Treatment. 
After having combated the inflammation by the anti- 
phlogistic treatment, in the same manner as though the 
worms had not existed, we administer some oleaginous 
draught, such as the oil of sweet almonds with lemon 
juice, taken by spoonfuls. The bitter anthelmintics, such 
as the helminthocorton, the worm-wood, the artemisia 
judaica are not suitable, except when there is no inflam- 
mation, or when it has been entirely dissipated. Benefi- 
cial effects are sometimes derived from the application to 
the abdomen of cloths steeped in oil, in which a few grains 
of camphor have been dissolved. 

ACUTE GASTRO-ENTERITIS. 

THE FORMS WHICH HAVE BEEN CALLED ATAXIC FEVER* 
ADYNAMIC FEVER, CAMP FEVER, YELLOW FEVER. 

Symptoms. 
First form. — When gastro-enteritis advances we ob*- 
serve nervous phenomena of a very irregular kind, such 
as tremor, delirium, visions, mental alienation, and pain- 



PRACTICE OP MEDICINE. 17 

ful sensations referred to different parts of the body. As 
the disease augments in intensity, the patient is agitated, 
seized with violent convulsions, and incapable of recog- 
nising any one; objects appear to revolve around him. 
From the irregularity of all these symptoms, authors have 
named this form ataxic fever. 

Second form. — The eyes fixed and haggard; deafness; 
the patient is as it were struck with stupor; the tongue at 
first red, becomes covered with a black coat; the teeth are 
encrusted with a fuliginous matter; fetid breath; total 
prostration of strength; agitated respiration; rejection of 
drink, or if the patient takes it, it falls mechanically 
into the stomach as it were through a funnel, and some- 
times passes into the larynx. As the disease advances, 
symptoms of putridity arise; fetid excrements and cada- 
verous smell of the cutaneous transpiration; the skin is 
covered with livid spots; aphthse appear in the mouth, 
toth internally and externally; the urine and other excre- 
tions are sometimes bloody, and the gums bleed easily. 
According to the predominance of particular symptoms, 
authors have given this disease the name of typhus, of 
camp fever, and of yellow fever. The ataxic form gene- 
rally precedes the adynamic. Sometimes the adynamic ap- 
pears at the very commencement of the attack; this takes 
place especially when it has been preceded by a latent 
phlegmasia which has suddenly exploded with violence. 

Causes. 
Gastro-intestinal irritation carried to its highest degree 
of intensity, the sanguineo-nervous constitution, a hot and 
moist atmosphere, the moral affections, and in general all 
the causes of intestinal phlegmasia. The sick confined in 
considerable numbers in the same place, produce a focus 
of heat and miasm, which, occasioning the same disease 
in persons exposed to the contaminated atmosphere, has 



18 THE PHYSIOLOGICAL 

given rise to the opinion that the disease is of a contagious 
nature; this is not the fact. 

Prognosis. 

The ataxic is less dangerous than the adynamic form, 
which we may regard as the last grade of the prostration 
of vital force, induced by an excessive inflammation of the 
intestinal canal and of the brain. They are both to be re- 
garded with less apprehension at the commencement of 
the malady than when it has continued for some time. 
Convulsive symptoms are less dangerous than those of 
stupor. When irritation has arrived at the last degree 
which we have described, there is no further hope. 

In general, every complication of gastro-enteritis ren- 
ders it more serious; but the danger is most imminent 
when it is complicated with cerebral disease, or with pe- 
ritonitis, or with pneumonia. 

Treatment. 
If the irritation is primitive and in its initial stage, we 
attack it with topical depletion at the epigastric region; 
if it be consecutive, we give emollient drinks, gum water 
acidulated with sulphuric or citric acid, lemonade; in a 
word, we employ the antiphlogistic treatment. The ab- 
straction of blood is dangerous when irritation has become 
very intense: under these circumstances our whole treat- 
ment will consist in keeping the patient in a cool atmos- 
phere, and in administering emollient injections together 
with drinks of the same kind. Tonics and stimulants of 
whatever kind should be rigidly proscribed, since it is a 
well known fact that the debility in these cases is only ap- 
parent. 



PRACTICE OF MEDICINE. 19 

REGIMEN OF CONVALESCENTS, 

AFTER AN ATTACK OF GASTRITIS OR GASTRO-ENTERITIS. 

After the symptoms of irritation have been allayed, the 
patient is sometimes reduced to a state of extraordinary 
marasmus, particularly if the disease has been of long con- 
tinuance. We commence by giving him small draughts 
of milk mixed with barley water or gum water, or with 
ptisan of mallows or linden, &c. If the appetite increases, 
and the tongue is no longer pointed and red, the patient 
may proceed to broths of a very light quality, the strength 
of which may be increased as convalescence advances; 
light soups may be used made with the farinaceous arti- 
cles, with rice, tapioca, vermicelli. If the patient im- 
proves under this regimen, he may be permitted to take 
comfits, bread, chicken, veal, beef, and the ordinary diet 
may ultimately be restored: but we must always feel our 
way with caution, and pay particular attention to the state 
of the tongue and of the pulse; if the tongue becomes red 
and the pulse excited under the employment of the pre- 
scribed regimen, we diminish the quantity of aliment or 
withhold it entirely. 

ACUTE COLITIS. 

Symptoms. 
Colitis may either pursue its course alone, or be accom- 
panied by enteritis. If it exists alone, the pain follows a 
direction from right to left towards the inferior part of 
the alimentary canal; these pains are accompanied with a 
sensation of twisting, languor, prostration, shivering, co- 
lic, and contusive pains in the arms and thighs. There 
is diarrhoea with dejections, at first of faecal, and after- 
wards of mucous and bloody matters. If the discharge be 



20 THE PHYSIOLOGICAL 

of pure blood, colitis assumes the name of dysentery. If 
the irritation is confined to the colon, fever is an unfre- 
quent concomitant, but it makes its appearance when the 
whole canal is involved. The pulse is accelerated, small, 
and wirey, and the thirst excessive; in this case the dis- 
ease has received from authors the name of putrid, bilious, 
mucous, or inflammatory dysentery, with ataxic or ady- 
namic fever, according to the grade of concomitant gastro- 
enteritis. 

Causes. 
The causes of colitis are nearly the same as those of 
gastro-enteritis. There are some substances, however, 
which pass through the superior part of the intestinal ca- 
nal without producing irritation, and which select, as the 
sphere of their action, the inferior part of this tube. Sup- 
pression of the cutaneous transpiration, cold, a transfer of 
irritation by metastasis, unripe fruit, laxative articles of 
diet, fatigue, long and forced marches, the immoderate 
use of purgatives, especially of those of the drastic kind, 
are the ordinary causes of gastritis. To these may be 
added irritation, originally seated in the upper part, and 
translated thence to the inferior portion of the canal. 

Prognosis. 
Attacked in its forming stage, colitis is dissipated with 
the greatest facility. It is seldom dangerous, unless under 
circumstances of great acuteness. In this case the vio- 
lence of the pain, and not of the inflammation, may de- 
stroy the patient. If it is complicated with gastro-ente- 
ritis, or any other irritation, the derangement varies with 
the intensity of the concomitant malady, and the consti- 
tution and strength of the individual. 



PRACTICE OF MEDICINE. 21 

Treatment. 

Leeehes applied to the margin of the anus, to the num- 
ber of fifteen, twenty, thirty, or forty, promptly reniove 
the disease. If there is a gastric or gastro-enteritic com- 
plication, recourse should be had to cupping or leeching 
over the affected part. These means must be seconded 
by diet and mucilaginous drinks. If the irritation extends 
to another part, it must be pursued with repeated applica- 
tions of leeches to the painful points. 

When colitis has diminished in intensity, and there is 
no fever, we very often succeed in dissipating it by the 
use of sago, arrow root, or tapioca jelly. Tonics, astrin- 
gents, and opium, are not remedies upon which we can 
place our dependance; we may, however, have recourse 
to them when the irritation is nearly subdued. 

CHRONIC PHLEGMASIA OF THE INTESTINAL 
CANAL. 

CHRONIC GASTRITIS AND GASTRO-ENTERITIS. 

In the acute, as in the chronic state, the phlegmasia of 
the digestive tube present many shades of difference. This 
diversity may be derived from the intensity of the irrita- 
tion; from the temperament of individuals; from age and 
sex; from alterations produced in the diseased tissues; 
from an inflammation of long standing, and, lastly, from 
the seat of the affection. 

First shade of Chronic G astro-enteritis with the form, 
called slow Fever, slow Nervous Fever, Tabes 
Mesenterica, Atrophia Infantilis. 



Symptoms. 



Febrile pulse, lassitude, prostration, heat, thirst, heat 
about the epigastrium, redness of the tongue. If there 



22 THE PHYSIOLOGICAL 

is no colitis the patient is constipated ; the conjuctiva is 
red; the circumference of the eyes is of a bluish tint; the 
skin is wrinkled, and as it were glued to the muscles; the 
urine is high-coloured, and deficient in quantity; the 
exacerbation, which occurs in the evening, is accompa- 
nied with sweats, particularly if the complaint is compli- 
cated with pulmonary irritation. All the febrile symp- 
toms are aggravated on the approach of evening. The 
patient often enjoys a respite from his complaints in the 
morning; he can attend to his affairs, and feels no disgust 
for food. As the disease advances, the loss of flesh be- 
comes extreme, this is what is denominated slow fever; 
if there is cerebral irritation, or convulsions, it is called 
slow nervous fever ; if there is tension of the abdomen, or 
a complication of colitis, it is named tabes mesenterica. 
In children it constitutes atrophia infantilis. 

Causes. 
All those of acute gastro-enteritis; but we may remark 
that this form, which we call sub-acute, is often the result 
of the bad treatment of the acute state. 

Prognosis. 

The termination of the disease varies with the duration 
and intensity of the malady; the sensibility of the subject; 
the treatment employed ; and the alterations produced in 
the tissues, which are the seat of the irritation. 

A cure is more easily effected in those who have not 
experienced many relapses, and who have not used stimu- 
lants improperly. Febrile gastro-enteritis, consecutive 
to the acute state, is much more difficult to cure than that 
which is premature, on account of the alterations which 
attend it. If there is engorgement of the glands, of the 
liver, or of the spleen, the disease is obstinate, but not 
desperate, provided we refrain from stimulants. Con- 



PRACTICE OF MEDICINE. 23 

siderable loss of flesh; ecchymoses; and scorbutic petechias 
are of an ominous character. If the patient loses his ap- 
petite; if he continually vomits up whatever he swallows; 
if diarrhoea supervenes upon all the other symptoms of 
debility, there remains but little hope. 

Second shade of Chronic G astro-enteritis, with a pain 
which is called Hepatic, Splenic, Phthisical. 

Symptoms. 
They differ but little from those of the preceding shade. 
Slow digestion, accompanied with a slight febrile excite- 
ment. Some relief seems to be derived from the adminis- 
tration of stimulants, with the view of aiding digestion, 
but in a short time the complaints of the patient are re- 
newed, and if he continues the use of these medicines, 
his state becomes more harassing every day. There is a 
deep sallow tint of the skin; pain is complained of in dif- 
ferent regions of the body; between the shoulders; at the 
cardiac region; in the liver; the spleen; and about the 
shoulder blades. This pain is called hepatic, when it is 
seated about the right shoulder; splenic, when about the 
left; and phthisical, when between the shoulders. We 
must beware of confounding these different forms of 
chronic gastro-enteritis with primitive affections of the 
liver, the spleen, or the lungs. 

Causes. 
The same as those of the preceding shade. 

Prognosis. 

From a bold and unsparing employment of stimulants, 

the patient will imagine himself better; this, however, will 

be at the expense of increased suffering, after the cessation 

of their action; but by a persevering use of demulcents, a 



24 THE PHYSIOLOGICAL 

gradual restoration to health will be effected. The danger 
varies, as in the preceding shades, with the intensity and 
duration of the disease, and the lesions produced by the 
irritation. 

Third shade of Chronic G astro-enteritis. — Cynorexia? 
Boulimia, Hypochondriasis. 

Symptoms. 
In this shade gastro-enteritis is not always accompanied 
with fever. There is redness of the point of the tongue; 
this is sometimes the only symptom, but most frequently 
it is attended with heat of the stomach. The state of the 
skin corresponds with that of this organ, and of the tongue. 
If the stomach is inflamed, the colour of the skin is higher, 
and the conjunctiva is redder. If we direct our attention 
to the seat of inflammation, we find the digestive process 
accelerated, but attended with pain; this is what is called 
boulimia. There is sometimes dyspnoea; a cough called 
gastric; palpitation; constriction of the heart; a sense of 
fullness and expansion of the heart, together with 
throbbing so great as to resemble aneurism. If irritation 
advances, the power of digestion is impaired, and al- 
though the patient eats with voracity, yet, he continually 
approaches a state of atrophy. In some subjects the urine 
is high-coloured and lateritious. If the patient is free from 
colic, he suffers from obstinate constipation. He is sen- 
sibly relieved by alvine evacuations, to procure which, 
he employs purgatives of every kind. From these he 
derives benefit at first, but they ultimately cease to pro- 
duce the same effect, and increase the disease by adding 
to the existing irritation. The symptoms present infinite 
varieties, and are so inconstant, that it would be impossible 
to produce an exact monograph of them. It is certain, 
however, that all the organic symptoms, and those of re- 



PRACTICE OF MEDICINE. 25 

lation, originate in inflammation of the stomach, since 
the application of leeches over this viscus, and a reduction 
of the food, together with a complete abstinence from all 
irritating and stimulating ingesta, have the effect of ar- 
resting the disease. 

If the irritation continues, the patient becomes thought- 
ful and melancholy, and is constantly absorbed in the con- 
templation of his own feelings; this constitutes hypochon- 
driasis, a disease whieh varies extremely in its form. The 
following are the ordinary symptoms: dyspnoea, slow and 
painful digestion, eructation, flatulence, rumination, violent 
spasm of the stomach, hiccough, a sensation of constriction, 
of twisting at the region of the stomach, borborygmus, the 
sudden development of a gas in the stomach, or the agitation 
of a fluid which the patient compares to a ball. Sometimes 
hypochondriacs think they can perceive their food in the 
act of passing the pylorus; by concentrating their attention 
upon the interior of their bodies, they acquire so extraordi- 
nary a tact, that no internal movement, however slight, can 
elude their observation. There are some who distinctly 
perceive the pulsations of the abdominal arteries. They 
universally believe that their disease is without a parallel, 
and it certainly is true that no two individuals can be 
found whose symptoms are perfectly identical. Those 
symptoms, however, which are indicative of gastric and 
enteritic irritation, are always found to exist, but the 
sympathies of the local irritation vary with constitution., 
age, sex, and occupation. 

Hypochondriasis does not then exist only in the mind 
of the patient, although this opinion has been held by 
some medical men, who, unable to assign either the seat 
or the cause of the malady, have preferred denying its ex- 
istence to acknowledging their ignorance. 



26 THE PHYSIOLOGICAL 

Prognosis. 
This shade of gastro-enteritis is most frequently met 
with among persons in affluent circumstances, who live 
well, and are addicted to the use of generous wines and 
alcoholic drinks. The bilious temperament predisposes 
to this disease; we, however, meet with it sometimes in 
scrofulous patients, who have been treated too freely with 
stimulants and tonics. There are individuals in whom we 
observe all the symptoms of hypochondriasis without the 
concurrence of these causes, yet this is an uncommon oc- 
currence. 

Treatment, 
If the antiphlogistic treatment is pursued, the disease 
will gradually disappear, but if the employment of all 
kinds of stimulants be persevered in, a treatment which 
has hitherto been almost universally resorted to, it will 
indubitably terminate in the development of an acute gas- 
tro-enteritis, which will be attended with greater danger 
from the circumstance of its supervening upon a chronic 
one. 

Fourth Shade of Chronic Gastro-enteritis. — Scirrhus 
and Cancer of the Stomach. 

Symptoms. 
These are common and peculiar symptoms: the com- 
mon are those of gastritis; the peculiar are those which 
indicate the presence of scirrhus. Its seat is the cardia, the 
pylorus, and occasionally some other part of the stomach. 
When the cardiac orifice is affected, there is pain and heat 
about the region of the heart; the heat is greater at the 
throat, and is immediately relieved by cold drinks. This 
tumour cannot be certainly discovered by the touch. At 
the pylorus the existence of the disease is more easily as- 



PRACTICE OP MEDICINE. 21 

certained by feeling; but still it may readily be confound- 
ed with other tumours which may be developed in the 
vicinity. Our doubts as to the nature of the disease are 
dispelled when to the other symptoms are added embar- 
rassed digestion, pain, regurgitation, and vomiting. Never- 
theless, the food sometimes passes along in small quanti- 
ties, notwithstanding the existence of scirrhous pylorus. 
In some cases the stomach does not reject the food unless 
it is taken in large quantities. In addition to these symp- 
toms, the colour of the skin is dull, and presents the as- 
pect which is called cancerous. It is difficult to pronounce 
upon the existence of scirrhus in the parietes of the sto- 
mach, even when a tumour is perceptible to the touch, 
because the gastro-colic epiploon may occasion the same 
sensation, when it is folded upon itself or engorged: we 
can only be assured of the existence of a tumour in the 
neighbourhood of the stomach, which may be a glandular, 
an adipose, or a scirrhous engorgement. But when it is 
accompanied with pain, and with a vomiting of acid, acrid, 
or dark-coloured matter, and with laborious digestion, the 
diagnosis is more certain. In fact, it is sufficient to know 
that there is irritation of the mucous membrane of the 
stomach, the particular mode of degeneration is only pro- 
bable. During the existence of these symptoms, the pa- 
tient loses his flesh, is sad and disconsolate; his condition 
is painful, and difficult to describe. It sometimes happens 
that a phlegmasia, involving the whole digestive tube, suc- 
ceeds the local inflammation. This phlegmasia is marked 
by the same symptoms as ordinary gastro-enteritis, viz. 
acute fever, red tongue, thirst, dry skin, general pros- 
tration, and marasmus. 

Causes. 
The predisposing causes are the lymphatic tempera- 
ment, and errors of diet. The occasional causes are gas- 



28 THE PHYSIOLOGICAL 

tritis, which determines an afflux of fluids to the irritated 
part, super-nutrition of the irritated tissue then takes place, 
whence arises the development of tumours which are hard, 
lardaceous, &c. 

Prognosis. 
The prognosis is generally unfavourable, if the diges- 
tion is very difficult, and to the well-ascertained existence 
of tumour are added the usual symptoms of gastritis. In- 
flammation sometimes perforates the parietes of the intes- 
tinal canal, and attacks the peritoneum. A violent peri- 
tonitis suddenly supervenes, to which the patient in a 
short time falls a victim. We may almost always be as- 
sured that perforation has taken place, when, after a long 
continuance of suffering, we witness the supervention of 
peritonitis and sudden death. 

Treatment of Chronic Gastritis and G astro-enteritis, 
with their different Shades. 
Chronic febrile gastritis and gastro-enteritis, not origi- 
nating in the acute form, require for their cure the same 
treatment as the acute. When they are consecutive to the 
acute state, the treatment requires certain modifications. 
If gastro-enteritis is only a continuation of acute gastritis, 
we must insist upon the prolonged use of a rigid diet and 
antiphlogistic remedies. If the patient is of robust con- 
stitution, the occasional application of twenty or thirty 
leeches to the epigastrium will be proper. But topical 
bleeding is contra-indicated by the existence of organic 
lesion discovered by tumefaction and hardness of the ab- 
domen, intestinal pains, cancerous complexion, continu- 
ance of accelerated pulse. Patience, time, and a mild 
diet are the only means from which we can reasonably 
expect a happy result. 



PRACTICE OF MEDICINE. 29 

Treatment of Cholera Morbus. 

When chronic gastro-enteritis presents itself under the 
form of cholera morbus, that is, when there is violent vo- 
miting of matter charged with bile and mucosities, accom- 
panied with acute pain at the epigastric region, with con- 
vulsions and cramps, especially after vomiting, we must 
not have recourse to tonics and excitants, for in this dis- 
ease, even when there is an absence of fever, we have to 
treat an irritation of the stomach, as dissection demonstrates. 

The indication is to allay the irritation of the stomach 
by cooling drinks, and particularly by local bleeding over 
the viscus, yet if the patient is prostrated, if the vomit- 
ing has continued three or four days before the physician 
is called in, if the face is haggard, and the pulse weak and 
fluttering, we must abstain from bleeding and adhere to 
emollient drinks. Sometimes the patient rejects all except 
water moderately sweetened with sugar, or even pure 
water, taken only in single mouthfuls. Emollient cata- 
plasms are applied over the epigastric region, and the feet 
and hands are immersed in water rendered stimulating 
with mustard. In some cases drinks should be entirely 
prohibited, as a single spoonful of simple water exaspe- 
rates the symptoms. Our remedial means are then con- 
fined to the administration of small emollient injections, 
to which may be added a few drops of laudanum. Ad- 
vantage is sometimes derived from the application of ice 
to the epigastrium, while the extremities are kept warm. 
After the employment of the antiphlogistic treatment, 
when the redness of the tongue has diminished, an opiate 
draught may be administered. 

If the disease passes from the chronic to the acute state, 
it is to be treated as an acute gastro-enteritis. 
5 



30 THE PHYSIOLOGICAL 

Treatment of Tabes Mesenterica, and of Congestions 
of the Live?' and Spleen. 
Formerly, when a patient digested badly, and had an 
enlargement of the liver or spleen, or a tumour in any 
other part of the abdomen, he was dosed with pretended 
deobstruents, such as saponaria, wild succory, and purga- 
tives, and if there was no fever, with quinine and many 
other kinds of tonics and stimulants. Whether fever ex- 
ists or not, this kind of medication is improper; we must 
address our remedies not to symptoms, but to the primi- 
tive seat of the irritation. We must therefore employ 
only the antiphlogistic method, any other treatment is ab- 
surd and dangerous. If this disease commences with the 
acute state, or from the chronic turns to the acute, the 
treatment must be the same as in acute gastro-enteritis. 

Treatment of the shade called Boulimia, Cynorexia. 

Antispasmodics and tonics only increase the appetite, 
by augmenting the irritation of the stomach, which is the 
cause of it. The indication is, therefore, to administer 
the insipid milky emulsions in large doses, prohibit high- 
seasoned food, and the vinous, bitter, or aromatic drinks. 
If we persevere in this treatment, the tongue at first be- 
comes red, white, broad, and moist, the patient falls into 
a kind of languor, and advances gradually towards a state 
of health. The demulcent treatment, consisting of muci- 
laginous and feculent substances, must be kept up for 
some time; and when the symptoms of gastritis have been 
entirely dissipated, we return gradually to the ordinary 
regimen. 

Treatment of Hypocondriasis. 
We must not lose sight of the fact, that hypochondriacs 
exaggerate their complaints, from having their attention 



PRACTICE OP MEDICINE. 31 

constantly directed to their viscera; but on the other hand, 
we must beware of believing that all their distress 13 im- 
aginary. They are undoubtedly affected with an irrita- 
tion of the digestive tube, which reacts upon the brain. 
This occasions the nervous symptoms, and the kind of 
monomania under which they appear to labour. We 
should then put them on a mild and vegetable regimen — 
a milk diet, if they digest it with ease. We prescribe 
moderate exercise, travelling, diversions, bathing, watery 
and unexciting beverages. If there be obstinate consti- 
pation, or the suppression of habitual haemorrhoids, we 
apply, from time to time, ten or twenty leeches to the 
verge of the anus, particularly at the customary period 
of the sanguineous flux; to this treatment we add emollient 
injections. 

ACUTE PERITONITIS. 

This is an acute inflammation of the peritoneum: it may 
involve the whole membrane, or one or more parts of it. 
The opinions of the ancients with regard to this affection, 
were very vague. What they regarded as peritonitis, 
was nothing but colitis or enteritis; for their description 
of it is precisely the same as that of the latter phlegmasia?. 
Peritonitis is never accompanied by diarrhoea; this is one 
of its characteristic features; now, the old writers con- 
tinually mention diarrhoea as attending it; which proves 
their total ignorance of peritonitis in the proper accepta- 
tion of the term. 

The peritoneal membrane, though destitute of sensi- 
bility in a state of health, yet possesses it to an extreme 
degree in the pathological condition. This membrane is 
less subject to inflammation than those which are possessed 
of sensibility to a greater degree. 



32 THE PHYSIOLOGICAL 

Symptoms. 

The symptoms are either local or sympathetic. The 
first are, burning pain, of a sharp and lancinating charac- 
ter, by which circumstance it is particularly distinguished 
from colitis. The diagnosis is likewise assisted by pres- 
sure, which sometimes becomes insupportable, to such a 
degree that the patient cannot endure the weight or con- 
tact of the clothes; this is not the case in colitis or 
enteritis. 

Sympathetic symptoms. — A small and hard pulse. 
The muscular apparatus appears to be in a state of con- 
striction. 

Peritonitis pursues a rapid course; in one, two, three, 
or at most four days, it attains its maximum of intensity. 
Obstinate constipation, the administration of injection 
being attendsd with pain and difficulty; ordinarily a tu- 
mefaction of the abdomen, which is renitent under pres- 
sure; muscular tremors; the knees are flexed upon the 
trunk; the pulse increases in rapidity; vomiting may occur; 
the tongue is sometimes of a blood-red colour. Finally, 
delirium supervenes, with total prostration, obtuse sensi- 
bility, and all the symptoms of ataxy. In puerperal 
peritonitis the tongue is foul; the abdomen soon becomes 
tense, because the system has many humours to be eva- 
cuated, an afflux of which to the irritated parts always 
takes place. 

We sometimes see peritonitis deriving its origin from 
a stomach irritated by the exhibition of emetics; or from 
a colon suffering in consequence of drastic purgation. 

Causes. 
Blows upon the abdomen, straining, the shock of vio- 
lent coughing, vomiting, a contiguous phlegmasia which 
lights up irritation in the peritoneum, a perforation of the 
stomach, of the intestines, or of the gall-bladder, giving 



PRACTICE OF MEDICINE. 33 

rise to extravasation into the peritoneal sac of substances 
to which it is not accustomed. 

Sometimes peritonitis is consecutive to a phlegmasia of 
the intestinal mucous membrane; then the peritoneum be- 
comes inflamed at certain points, corresponding to the 
seats of the mucous irritation. Peritonitis consecutive to 
inflammation of the intestines, can only be accounted for 
in this manner. Inflammation of the mucous membrane 
communicates itself first to the muscular coat of the intes- 
tine, it then attacks the cellular, and afterwards the serous 
membrane, or else it assails the womb, the bladder, the 
kidneys, &c. We seldom meet with primary peritonitis. 

Puerperal peritonitis is frequently encountered as the 
consequence of laborious delivery, or of the retention or 
the suppression of sanguineous evacuations. The barbar- 
ous custom of administering hot wine and other tonics 
immediately after delivery, may give rise to inflammation 
of the womb, and, as a consequence, to that of the perito- 



Prognosis. 

This is one of the most dangerous inflammations. It is 
never cured without the assistance of art, but sometimes 
the efforts of art, badly directed, accelerate its ravages. 

If the subject be of a very irritable temperament, the 
heart may labour under constriction to such a degree as 
to give no indication of fever. 

Should fever make its appearance after the employment 
of antiphlogistics, it is a favourable sign; it is a proof that 
the constriction has ceased. 

Treatment. 
It should be of the most active kind. The inflammation 
should be dissipated before the peritoneum becomes en- 
cumbered by the accumulation of its own excessive sccre- 



34 THE PHYSIOLOGICAL 

tion. General and local blood-letting. If there is con- 
striction of the pulse, or if the peritonitis is violent, vene- 
section must always precede the application of leeches; in 
fact, this procedure is advantageous in all cases. The ten- 
sion of the abdomen would with difficulty yield to the ap- 
plication of leeches alone. 

We must afterwards pursue the peritonitis with the ap- 
plication of leeches to every part of the abdomen to which 
the pain is translated, and in which it manifests itself. 

The number of leeches must be considerable, otherwise 
the inflammation will advance with rapidity. From thirty 
to one hundred may be employed at once, or at two or 
three different times, according to the age and constitution 
of the patient, and the intensity of the inflammation. The 
warm bath. 

Fomentations are employed, but with prudence and re- 
serve. 

Lavements are useless, and sometimes dangerous; they 
always awake pain or augment it. 

CHRONIC PERITONITIS. 

It may be consecutive to the acute stage of peritonitis, 
yet when the disease is very acute it rarely becomes 
chronic, as it is either promptly cured, or rapidly termi- 
nates in death. It may likewise be primitive. 

Symptoms. 

Peritonitis, primitively chronic, is hardly ever accom- 
panied by fever: the reverse is the case when it is conse- 
cutive to the acute state. 

Tumefaction of the abdomen with resistance to pres- 
sure; constipation, owing to the pain of the peritoneum 
opposing the peristaltic movements of the intestines. The 
patient sometimes has a deceptive feeling of a want to 



PHACTICE OP MEDICINE. 35 

evacuate the bowels. The same thing occurs in other 
cases; in irritation of the bladder the patient thinks he 
experiences the want to pass his urine; in irritation of the 
stomach he experiences a deceptive call to stool, &c; this 
takes place because the irritation determines a sensation 
analogous to that produced by the presence of foreign 
substances in the part affected. 

Causes. 

Pressure, falls, straining in coughing, efforts in raising 
weights, pains of the belly; perhaps rheumatism may be 
enumerated among the causes. 

Inflamed ovaria often occasion chronic peritonitis. 

It may succeed a chronic pleurisy, or it may be the ef- 
fect of it, and vice versa. 

Prognosis. 

Chronic peritonitis may be mortal in two ways — by 
dropsy, or by marasmus, with hardness of the abdomen. 

Dropsy supervenes after the lapse of a variable time. 
Marasmus is a necessary consequence of the defect of nu- 
trition, resulting from peritoneal inflammation, which in- 
jures the functions of the intestines. 

Rupture of the peritoneum is sometimes observed as a 
consequence of chronic gastritis or peritonitis. In this 
case a tympanites supervenes, which must not be con- 
founded with dropsy. The fatal issue is then at hand. 

Fluids extravasated in the cavity of the peritoneum, 
have been observed to be very promptly absorbed, and 
particularly when an inflammation has occurred in another 
part. Ubi dolor, ibi Jhtxus. It is for this cause also that 
fluids accumulate in the peritoneum when it is the seat of 
an irritation. 



36 THE PHYSIOLOGICAL 

Treatment. 

This disease is never cured without the assistance of 
art. The resources of medicine are, however, unhappily 
very few. The antiphlogistic treatment is first to be tried, 
and the regimen is to be regulated in the same manner 
nearly as in chronic gastritis. 

Gentle diuretics are sometimes in place here. 

When the subject is strong and muscular, the dullest 
faculty of observation will perceive the propriety of the 
abstraction of blood. If the flesh is flaccid, and the sub- 
ject weak, blood-letting is contra-indicated. 

Medicinal soaps, bitters, alkalies, avail nothing — abso- 
lutely nothing. Milk, fresh vegetables, cooked fruits, 
light farinaceous slops, water for drink: these articles, and 
nothing more stimulating, should be employed. 

INFLAMMATION OF THE LIVER. 

HEPATITIS— ICTERUS. 

Hepatitis consists in an inflammation of the liver. It is 
idiopathic or sympathetic. Falls, foreign bodies, violent 
concussions, produce the former kind. 

The second or sympathetic, which is of much more fre- 
quent occurrence, is almost always produced by stimula- 
tion of the intestinal canal. 

Hepatitis is much more rare than it has been represent- 
ed to be by authors: duodenitis and hepatitis have been 
by them mistaken for this disease. 

In inflammation of the brain, the liver is sometimes 
found to become inflamed by sympathy; for as the mucous 
membrane of the digestive organs exercises an influence 
over the brain, so in return does the brain operate upon 
the mucous membrane of the intestines, and consequently 
upon the liver. 



PRACTICE OF MEDICINE. 37 

The bile may be poured into the duodenum in abund- 
ance, although there be no inflammation of the liver. The 
stimulation of the excretory ducts of the liver is sufficient 
to produce this effect, for, according to the observation of 
Bichat, the secretions are more abundant when these ducts 
are stimulated: this takes place in duodenitis, when the 
orifice of the ductus choledochus is inflamed. But the 
bile sometimes cannot be excreted on account of a spasm 
of this orifice; it is then absorbed, and gives rise to ic- 
terus. 

Pains, tumefaction in the region of the liver, varying 
according as the inflammation is superficial or deep-seated. 
Nausea, bitter taste, tongue greenish, and red at the point, 
constipation, urine depositing a lateritious sediment, the 
skin covered with perspiration, and often of a sallow tint. 
The jaundiced colour, or icterus, does not occur except 
when the bile cannot flow freely through the excretory 
ducts. 

Prognosis. 
It sometimes terminates by an epistaxis, which gene- 
rally occurs from the right nostril. Suppuration and 
concretions may occur, or it may pass into the chronic 
state. 

Treatment. 
This disease should not be abandoned to nature. Good 
effects are obtained from leeches, if there is not as yet a 
fuliginous state of the mouth, and if peritonitis or pros- 
tration has not occurred. They should be applied in great 
numbers, for example, forty, fifty, sixty, eighty, or one 
hundred, according to the age and strength of the patient, 
and the intensity of the inflammation. If acute hepatitis 
be preceded by chronic gastritis, or hepatitis, which frc- 



38 THE PHYSIOLOGICAL, 

quently happens, the cure will be difficult, and perhaps 
impossible. 

Neither emetics nor blisters are to be employed. 

Leeches, or cupping, and slightly acidulated demulcent 
drinks, are the only remedial means indicated. The diet 
must be more or less severe. 

If an abscess opens externally; if a fistula is established; 
the case is to be treated in the same manner as any other 
abscess. 

CHRONIC FEBRILE HEPATITIS. 

It is impossible to establish the diagnosis of the dif- 
ferent lesions which supervene in chronic hepatitis. Is 
there abscess, ulceration, calculi? The determination of 
these questions is of no practical utility, for we can never 
be assured of these states, until dissection reveals them. 

All that it is essentially useful to know is, that chronic 
hepatitis is an inflammation of the liver, distinct from 
gastritis and peritonitis. 

Prognosis. 

Chronic febrile hepatitis is always a serious disease. 

Change of structure in the liver does not alone produce 
death, but the latter is occasioned by the digestive organs 
participating in the irritation, or by their being its primi- 
tive seat. 

Chronic febrile hepatitis terminates frequently in dropsy 
or marasmus. 

On dissection, abscesses, cysts, ulcerations, perforations 
of the liver, and biliary calculi, are discovered. It is 
seldom that deep abscesses make their way to the ex- 
terior. 



PRACTICE OF MEDICINE. 39 



CHRONIC HEPATITIS, 



NOT FEBRILE. 



It is this disease that has been called by authors en- 
gorgement of the liver: the name of sub-inflammation ap- 
pears more suitable. 

It makes its appearance often as a sequela of inter- 
mittent fever. 

In tumefactions of the liver, there is almost always com- 
plication of duodenitis and jejunitis. 

The case of livers affected with a fatty degeneration, is 
nothing more than hepatitis of this kind, generally occa- 
sioned by duodenitis. 

Prognosis. 
If the liver is alone the seat of irritation, there is hope, 
but the danger increases if the inflammation involves the 
digestive tube; in this case the present form becomes as- 
similated to the preceding. 

Treatment. 

Antiphlogistics and revulsives. If the disease is not 
very intense, local depletion by leeches or cups over the 
region of the liver. 

We should abstain from leeches, if there is vomiting 
and anorexia. In other respects the treatment is the same 
as that of chronic gastritis. 

Bitters, myrrh, aloes, aromatics, the deobstruents, acrid 
substances, the pills of Morton, so extravagantly lauded, 
should be rejected as so many poisons. 

The thermal waters, administered internally, are often 
injurious. If recourse is had to these means, it should be 
done in such a manner that the stomach be not irritated. 



40 THE PHYSIOLOGICAL 

Douching over the seat of the affection has sometimes pro- 
duced very good effects. 

After the administration of antiphlogistics, we may 
employ moxa, issues, blisters, mercurial frictions, from 
which great benefit has been derived in this case. 

But the most suitable measure is to employ with un- 
wearied assiduity mucilaginous drinks, and a mild and light 
regimen, which in some cases must be continued for years. 

INFLAMMATION OF THE SPLEEN. 

SPLENITIS. 

The spleen is an appendage of the digestive organs, 
which appertains entirely to the circulatory apparatus, and 
has very little sympathy with other organs. 

We sometimes meet with enlargement of the spleen as 
a consequence of intermittent fever. 

The moral affections may also suddenly give rise to an 
extraordinary tumefaction of this organ. This is a true 
sanguineous congestion. Inflammation of the spleen, 
whether acute or chronic, is not very painful; its treat- 
ment is absolutely the same as that of gastritis. 

The case is the same with regard to the pancreas, the 
affections of which it is very difficult to determine during 
life. 

PHLEGMASIA OF THE URINARY APPARATUS. 

(kidneys and bladder.) 

The reins and the bladder are susceptible of peculiar 
irritations. The treatment appropriate to them is likewise 
peculiar. We shall treat first of the kidneys. 

The kidneys, like most of the secretory organs, have 
many sympathies with other parts of the body. Irritation 
of the kidneys is with facility transmitted to the bladder, 



PRACTICE OP MEDICINE. 41 

and vice versa. Violent passions may give rise to affec- 
tions of the kidneys. The too frequent employment of 
certain diuretics, as nitre, camphor, cantharides, spirituous 
drinks. All the diseases of the abdomen may affect the 
kidneys: they may also become the seat of a metastasis. 

Youth and old age are more subject to this disease than 
the middle period of life; and men more than women. 

Falls, long confinement to bed, devotion to study, favour 
the development of this affection. In fact, there are no 
diseases to which excess in study, in the pleasures of the 
table, and in venery, may not give rise. Inflammation of 
the kidneys is called nephritis. It is acute or chronic. 

ACUTE NEPHRITIS. 

Symptoms. 

Pains in the region of the kidneys, more or less acute, 
but sometimes atrocious; pressure renders them more in- 
tense; sometimes a slight tumefaction of the diseased side 
is perceptible. 

This inflammation may be reflected on other organs in 
two opposite directions: there may arise from it pain of 
the testicle, and retraction and pain of the spermatic cord. 
The irritation is often repeated in the stomach; this con- 
stantly occurs when the inflammation is very intense. Be- 
sides the signs of nephritis, we then meet with all the 
signs of gastro-enteritis. In the acute stage the urine is 
ordinarily bloody, and in small quantity, or suppressed; 
there are pains of the bladder. 

This inflammation is not ordinarily very intense, ex- 
cept in case of violence produced by a foreign body; it 
may then rise to the degree of phlegmon, and manifest 
itself by all the ordinary symptoms that characterize 
ibis affection, such as throbbing pain, full pulse, &c. 



42 THE PHYSIOLOGICAL 

It is not, however, to be understood that phlegmon 
never occurs, under the influence of other causes than 
those enumerated. 

Prognosis. 
The acute stage is cured, or passes into the chronic. 
This phlegmasia does not by itself occasion death; the 
fatal issue is owing to the gastritis which precedes or 
follows it; sometimes it is in consequence of peritonitis. 
This last species of nephritis is rare. When prostration 
occurs, it is a sign that the inflammation has deeply affect- 
ed the mucous membrane of the intestines, as in all the 
cases in which irregular nervous and adynamic symptoms 
supervene in the train of any irritation whatever. 

Treatment. 

In the acute state, local bleeding; if inflammation is very 
intense we must commence with general blood-letting. 
For drink, decoctions of mallows, flaxseed, of milk, of 
sweet almonds. If the pain is violent, if spasms and con- 
vulsions occur, we may give ether or laudanum in a large 
quantity of water. 

Warm bath. To derive advantage from this, the patient 
must remain in it for a long time. Too hot or too cold, it 
is dangerous. 

Constipation must be obviated by the administration of 
emollient enemata. 

Camphor may be employed in irritations of the kidney, 
yet we should use it with caution, or rather abstain from 
it in the very acute state. 

If there is haemorrhage, it should not be arrested by 
astringents, but the demulcent treatment is to be con- 
tinued. 



PRACTICE OF MEDICINE. 43 

CHRONIC NEPHRITIS, 

AND NEPHRITIC COLIC. 

It is ordinarily consecutive to the acute, and does not 
differ except in the intensity of the symptoms. Yet it 
sometimes happens that there is no acute state, and that 
the disease commences by an attack of nephritic colic, 
which leaves in the interval a more or less decided state 
of suffering, continuing until the exacerbation appears 
again. 

Symptoms of Nephritic Colic. 

Pains in the lower part of the flank, extending along 
the spermatic cord to the testicle, and even to the thigh, 
loss of appetite, nausea, vomiting, heat and swelling in the 
region of the kidney, as in acute nephritis. The differ- 
ence is that the frequency of the pulse is less considerable. 
The colics resemble much those of the colon. The pains 
become lancinating and penetrating in the region of the 
kidney. Sometimes convulsions of the superior extremi- 
ties occur. The patient writhes with agony, moves from 
place to place, despairs of recovery, and presents a deplo- 
rable aspect. 

The duration of the attack is entirely indefinite; it may 
continue whole days and even weeks; at other times it 
ceases after the lapse of a few minutes. After some time 
the urine carries along with it gravel, and the disease 
often terminates after their evacuation. The patient af- 
terwards enjoys comparative ease. 

The return of the attack is determined by atmospheri- 
cal vicissitudes, strong moral affections, cold feet, excess 
in spirituous drink, violent exercise, coitus, and all the 
ordinary causes of acute nephritis. 



44 THE PHYSIOLOGICAL 

Nature of Nephritic Colic. 
It is an irritation of the kidneys, which sometimes, but 
not always, gives rise to calculi. It is incorrect to attri- 
bute it in every case to the sole cause of calculi in the 
kidneys and in the ureters. These calculi are in the first 
place the effect of irritation before they become its cause. 
It often alternates with gout, rheumatism, the catamenia, 
haemorrhoids, herpes, and other cutaneous eruptions. 

Prognosis. 

The disease may disappear if it is attacked before al- 
teration of structure supervenes; it may be replaced by 
another irritation; it may persist in the kidney, render it 
tuberculous, produce in it calculi, transform it into a kind 
of sac which fills the abdomen, and which contains a va- 
riable quantity of urine; it may produce scirrhus, or can- 
cer of the kidney, and bring on dropsy. Finally, it may 
give rise to irritation of the principal viscera, to maras- 
mus, and death. 

On dissection we. discover the kinds of alteration of 
which we have just spoken. 

Treatment of Chronic Nephritis, and of Nephritic 
Colic. 

The same as that of acute nephritis: leeches over the 
region of the kidney to the number of twenty, thirty, 
forty, or fifty, emollient cataplasms, fomentations and 
enemata, demulcent drinks, a slightly camphorated emul- 
sion, frequent warm bathing, mild milk diet, mental and 
corporeal quietude. If, notwithstanding repeated bleed- 
ings and the antiphlogistic regimen, the colic continue, 
if the pains extend to the spermatic cord, and if there be 
convulsions and vomiting, we should suspect the presence 
of a stone in the ureter : in that case we strenuously en- 
force the employment of baths, enemata, and the oleagi- 



PRACTICE OF MEDICINE. 45 

nous preparations, which, by keeping up an open state of 
the bowels, favour the passage of the calculi. We may- 
try pills of soap, the balsam of copaiba, diuretic drinks; 
but these should not be resorted to until after the employ- 
ment of the antiphlogistic regimen. 

To prevent a return of the attack, the patient should 
use a mild diet of vegetables and milk in moderate quan- 
tities, he should take gentle exercise, and abstain from 
spirituous liquors and venereal excesses. The employ- 
ment of the mineral waters which contain carbonic acid 
may be useful as a diuretic. The thermal sulphurous 
waters, used in douches upon the region of the kidney and 
in drink, may, with the balsamic substances, act in an ef- 
fectual manner. These means are especially appropriate 
to the case of lymphatic and exsanguious subjects; but 
if the constitution is dry and nervous, if there is constipa- 
tion, and a sense of burning in the bladder, if the urine is 
high-coloured and scalding, the internal use of the thermal 
waters will only exasperate the irritation. Our treatment 
must then be confined to antiphlogistics. When the pains 
persist obstinately, notwithstanding the treatment, and 
the urine is altered from its natural state, thick, purulent, 
dark-coloured, and we have reason to believe there is al- 
teration of the organ, stimulants are contra-indicated. The 
antiphlogistic regimen, a few grains of camphor combined 
with opium to alleviate pain, and the mildest diuretics, 
are the means to which we should have recourse. Cam- 
phor and opium may be used in fomentations over the 
kidneys, if the internal employment of them augments 
inflammation. 

When chronic nephritis can be traced to the recession 
of a cutaneous eruption as its cause, besides the emollient 
treatment indicated above, the thermal waters in douches 
areemployed with success; revulsives, suchasthemoxa, dry 
cupping, blisters, made without cantharides, the employ- 
7 



46 THE PHYSIOLOGICAL 

ment of which is never proper in the phlegmasia of the 
urinary apparatus, on account of the irritation which they 
determine in the kidneys or in the bladder. Finally, if 
nephritis is accompanied with the suppression of an habi- 
tual haemorrhage, the means proper to restore this evacua- 
tion must be resorted to. However, as the suppression of 
a haemorrhage is more frequently the effect than the cause 
of an irritation, this haemorrhage would reappear sponta- 
neously on the cessation of the phlegmasia. 

ACUTE PHLEGMASIA OF THE BLADDKK. 

CYSTITIS. 

Symptoms. 
Continued burning and lancinating pains in the region 
of the bladder, frequent discharge of urine, dysuria or 
ischuria, sometimes a tumour above the pubis, vomiting 
and tenesmus. A greater or less number of these symp- 
toms may be met with, or they may present some parti- 
cular shades, according to the intensity of the disease, or 
the irritability of the subject. Sometimes the irritation 
fixes itself on the mucous membrane, it then receives the 
name of catarrh: this often passes into the chronic state. 

Causes. 
All those of inflammation, and particularly those which 
act directly upon the bladder, such as cantharides, spiri- 
tuous drinks, external violence, calculi, urine retained too 
long, and distending the bladder, irritations of the canal of 
the urethra, which sometimes extend to the mucous mem- 
brane of this viscus, phlegmasiae of the kidneys, in which 
the bladder readily participates, as well as in those of the 
verge of the anus, or of the rectum, of the vagina, and of 
the uterus. 



PRACTICE OF MEDICINE, 47 

Prognosis. 

It is always unfavourable. The acute phlegmasia may 
become chronic, if it be not promptly arrested, or the in- 
flammation may extend to the contiguous viscera, and be- 
come mortal. When it advances with rapidity, there are 
delirium, convulsions, vomiting, extreme sensibility of 
the hypogastrium. If the urine accumulates in great quan- 
tity, and is not evacuated either by means of the catheter 
or by puncture, the bladder may burst, and this case is 
ordinarily fatal. 

Dissection. — Thickening of the coats of the bladder, 
which sometimes considerably diminishes its capacity; 
perforation of this viscus, peritonitis, alterations of the 
neighbouring viscera, traces of irritation in the stomach, 
and even in the brain, if the disease has been attended 
with fever. 

Treatment. 

General and local bleeding by means of cups and leeches 
applied to the perinaeum or hypogastric region. We must 
act boldly and without delay; for this phlegmasia advances 
rapidly, and may promptly occasion organic changes, 
which it will afterwards be difficult and often impossible 
to remedy. We resort, time after time, to topical deple- 
tion, if the inflammation does not yield. We must not 
hesitate to apply forty, fifty, sixty, seventy, or even a 
greater number of leeches at a time. In addition to this, 
baths, cataplasms, fomentations, and emollient drinks must 
be employed. Neither camphor, turpentine, nitre, opium, 
nor the acids are to be employed. The antiphlogistic 
treatment, rigorously employed, is the only curative means 
to be resorted to. The other pretended remedies arc ab- 
surd, and not founded upon a consideration of the nature 
of the disease. 

This treatment, and especially the application of leeches, 



48 THE PHYSIOLOGICAL 

almost always succeeds in removing the retention of 
urine, by allaying the irritation of the bladder, or its 
neck, which gives rise to it. Where this effect cannot be 
obtained, we resort to the introduction of the catheter, 
and if this operation cannot be performed, we resort to 
the puncturing of the bladder. 

CHRONIC PHLEGMASIA OP THE BLADDER. 

CATARRHUS VESICJE. 

Symptoms. 

When the mucous membrane of the bladder is alone 
affected, we discover it by the following signs: — pressure 
upon the pubic region, or upon the perinaeum, excites no 
pain, and neither tumour, heat, nor pulsation is percepti- 
ble; the phenomena are only local; sometimes there is 
itching about the extremity of the gland, and in the fossa 
navicularis. 

After the lapse of some time, if the irritation is not ar- 
rested, whitish mucosities, of a fetid and purulent charac- 
ter are observed floating upon the urine. The urine is 
sometimes lateritious, dark-coloured, or sanious. If the 
disease advances, the patient retains his urine for a shorter 
period, and the pain becomes more insupportable, indi- 
cating disorganization. There are in this case, sleepless- 
ness, agitation, thirst, nervous irritation, cough, symptoms 
of gastritis, or peritonitis; sometimes the pains become 
lancinating, agonizing, and continued; hectic fever super- 
venes and closes the scene. 

Causes. 
The same as those of acute inflammation of the bladder, 
of which it is frequently the sequela. 



PRACTICE OP MEDICINE. 49 

Prognosis. 

When the disease is of long standing, the cure is diffi- 
cult. If it is recent, it is removed with sufficient facility. 
When there is profound organic alteration, there is no 
hope. If the disease depends upon a calculus, it may be 
cured by its extraction, if there be no complication of 
organic alteration. 

Dissection demonstrates but too clearly the difficulty of 
curing catarrh of the bladder. We find the membranes 
thickened and fungous; we observe granulations, tuber- 
cles, and lardaceous tissues: we then become sensible that 
there are no specifics for these affections. 

Treatment. 

If the affection is recent, the antiphlogistic treatment 
must be employed; leeches should be repeatedly applied, 
sometimes to the perinseum, and sometimes to the hypo- 
gastric region, to the number of eight, ten, or twelve. 
Demulcent drinks should be used, such as barley water, 
and the decoctions of the mucilaginous plants, or mild 
diaphoretic draughts: vegetable food in moderate quan- 
tity, abstinence from wine, unless largely diluted with 
water, and still more from spirituous liquors, from coffee, 
tea, punch, &c. 

Instead of small partial bleedings, it is sometimes useful 
to commence with the application of a great number of 
leeches at one time, for example, thirty, forty, or fifty. 
We should not despair of effecting a cure as long as the 
urine is not purulent. If the antiphlogistic treatment has 
been employed for a longtime without success, we should 
have recourse to the injection of emollient fluids into the 
bladder; to revulsives externally; to issues; moxa; vesi- 
catorics without cantharides. 

The medicinal soaps, the balsamic articles, such as 
copaiba, the essential oils, and uva ursi, sometimes afford 



50 THE PHYSIOLOGICAL 

relief; but these are stimulants whose action it is impossi- 
ble to ascertain beforehand; in no case should we employ 
them, unless they have been preceded by the antiphlo- 
gistic treatment. These medicines, which have been so 
lavishly praised, are beginning to lose much of their 
credit. 

SEQUELS OF THE AFFECTIONS OF THE URINARY APPA- 
RATUS. 

DIABETES. 

An abundant secretion of urine, disproportionate to the 
quantity of drink. Diabetes has been divided into diabetes 
mellitus, and diabetes insipidus. 

Symptoms. 
The most prominent symptom is the remarkable in- 
crease of the secretion of urine, it would seem as though 
the whole body would melt away in these excessive 
discharges. The urine is, at first, insipid, or at least has 
only its natural taste; but as the disease advances it ac- 
quires a sweet taste, and assumes a greenish tint. Con- 
tinual ardent thirst; sometimes a voracious appetite; 
parched mouth; the skin dry, and sometimes scaly; 
oedema of the feet and hands; acrid heat of the skin with- 
out perspiration; deep dejection; hectic fever, and death. 

Causes. 
In general but little known. Yet we may regard, as 
occasional causes of diabetes, all substances which have an 
irritating action upon the kidneys, whether directly or 
indirectly, such as diuretics, spirituous drinks, calculi, 
the action of cold. The muco-saccharine articles, which 
have been placed among the causes of diabetes, do not 
seem capable of producing this effect. 



PRACTICE OP MEDICINE. 51 

The proximate cause of diabetes, or rather the nature 
of the disease is ordinarily an irritation. This irritation is 
primitive in the kidney, or it is transmitted to it from the 
stomach, the ureters, or the bladder. The results of this 
irritation are infinitely varied; it gives rise at different 
times to the formation of small calculi, to softening, to 
scirrhus, to atrophy, to ulceration of the kidney, &c. 
With regard to the secretion of urine, irritation of the 
kidneys must necessarily produce a change in its quantity 
and quality. Sometimes, in fact, the secretion of urine 
is diminished, and even entirely suppressed under the in- 
fluence of an inflammation of the kidneys; at other times, 
it is augmented, either temporarily, as in an attack of 
hysteria, or during a long time, as in diabetes. The 
quantity of urine is then the result of irritation of the 
kidney. We shall not, therefore, be surprised that the 
quality of urine is equally variable, for it is the nature of 
the secretory organs to elaborate different matter, when 
their action is modified by an inflammation. Thus the 
urine may be charged with blood, with mucus, with 
gravel, with a larger or smaller proportion of uric acid, 
or of the hydro-chlorate of soda, with saccharine matter, 
&c. owing to no other reason than the abnormal condition 
of the organ that secretes it. The urine may therefore be 
saccharine or otherwise, as happens in diabetes, on ac- 
count of irritation of the kidney, without seeking for an 
explanation of the phenomenon in any other cause. Dia- 
betes mellitus, however, indicates a more advanced stage 
of disorganization than diabetes insipidus. 

Dissection proves, beyond the possibility of question- 
ing it, the truth of the preceding theory. We find, in 
fact, in the kidneys, or in the bladder, or sometimes in 
the stomach, all the signs which indicate that these organs 
have been a prey to the ravages of inflammation. These 



52 THE PHYSIOLOGICAL 

alterations are the same as those which we observe as the 
consequence of nephritis. (See Nephritis.) 

Prognosis. 

When diabetes is not arrested at its commencement, it 
is difficult to cure. When it supervenes on an old ir- 
ritation of the kidneys, it is generally incurable, as 
there are generally in that case organic alterations. In 
general the danger is great in diabetes mellitus, which 
variety is not met with, unless the disease has continued 
for a long time. Tonics, astringents, the exclusive use 
of black meats, abstinence from aqueous drinks, have all 
in their turn been prescribed, but without success. 

The antiphlogistic treatment has been used with no 
happier results. This is probably owing to its not having 
been employed sufficiently early, or to its not having 
been persevered in for a proper length of time; for no 
treatment would succeed, which is not commenced until 
organic changes have occurred. 

,. At the commencement of this disease we do not hesi- 
tate to employ leeches, and to resort with confidence to 
a treatment similar to that of acute nephritis; and if there 
is a complication of irritation of the stomach, of the 
bladder, &c. we treat them by the means indicated in 
such cases. 

The employment of urea has lately been highly ex- 
tolled in this affection, but the trials have not been suffi- 
ciently numerous to determine its utility. 

Many instances of cure have been cited, obtained by 
the exclusive use of a diet of fatty substances, and par- 
ticularly of lard, persevered in until the diabetes is arrest- 
ed, without the addition of any other article of food. The 
disgust and nausea which the long continuance of this 
treatment must occasion, should not discourage the pa- 



- PRACTICE OP MEDICINE. 53 

tient; for it appears that hitherto no means have been 
equally successful, after the failure of the antiphlogistic 
treatment. It succeeds best in lymphatic and weak sub- 
jects; in those of a sanguine irritable temperament, the 
same success would probably not be obtained, but the 
trial might be made. Yet if there be irritation of the 
stomach, this treatment is not appropriate. Country air 
and amusement powerfully assist in the cure. 

PHLEGMASIA OF THE GENITAL ORGANS. 

IRRITATION AND INFLAMMATION OP THE UTERUS, ME- 
TRITIS. 

Symptoms. 

In the acute state this phlegmasia is accompanied with 
horrid pain. The diagnosis is not difficult. Tumour 
above the pubis, sensible to the touch, and felt by intro- 
ducing the finger into the vagina. Burning heat, pains, 
throbbing as in the phlegmonous affections. Sometimes 
the tumefaction and sensibility extend to the labia pu- 
dendi and the neighbouring parts ; the passing of the 
urine is painful. As the womb has numerous sympathies 
embracing most of the organs, there are besides these 
local symptoms, sympathetic ones of a very prominent 
kind, the principal of which are the following: excessive 
pains in the groin and in the thighs, disorder of the sto- 
mach and of the brain, fever. This phlegmasia is rarely 
confined to the uterus, it involves the peritonaeum, the 
lower belly becomes hard and resisting, and the whole 
abdomen soon participates in this condition, meteorism. 

Causes. 
Every thing that acts mediately or immediately upon 
the uterus: the abuse of venery, continence, pregnancy, 
8 



54 THE PHYSIOLOGICAL 

delivery, falls, surgical operations for the extirpation of 
polypus or fungus, or to destroy ulcers; the application of 
the forceps, the introduction of the hand into the womb, 
criminal attempts to produce abortion, the excessive use 
of irritating substances, whose action is chiefly directed 
to the uterus, such as rue, savin, saffron, &c. Irritation 
of the intestinal canal and peritonitis may produce this 
disease. This irritation may likewise be derived from the 
brain, but in that case the ovaria appear to be excited in 
the first place, as being more immediately under the in- 
fluence of this organ, and from them the irritation extends 
to the uterus. 

Prognosis. 
If the phlegmasia is not seasonably arrested, it may, as 
we have already said, become complicated with peritonitis, 
and terminate fatally. The acute state generally termi- 
nates in ten or fourteen days in health, in death, or in 
the chronic state. 

Treatment. 
The antiphlogistic treatment should be promptly and 
boldly pursued. The treatment should commence with 
general venesection, and this should be followed up by 
the application of from forty to eighty leeches upon the 
hypogastric region, according to the gravity of the symp- 
toms, and the age and constitution of the patient. Emol- 
lient drinks, the warm bath, fomentations upon the hypo- 
gastric region, mucilaginous injections. Injections per 
vaginam are painful and useless. We repeat the topical 
depletion if the inflammation does not yield on the first 
application. Any hesitation or delay, may, as in perito- 
nitis, prove fatal. 



PRACTICE OF MEDICINE. 55 



SEQUELS OF THE PHLEGMASIA OF THE 
UTERUS. 

ACUTE CATARRH OF THE UTERUS. 

Uterine catarrh, otherwise called fluor albus, or leu- 
corrhcea,is characterised externally by a whitish lactiform 
discharge. It may be acute, and make an approach to 
metritis, described above, or it may be chronic : the latter, 
properly speaking, is the disease called fluor albus. 

Symptoms. 

Heat, pain, a sense of weight and fulness in the pel- 
vic basin, the neck of the uterus is lower than usual, and 
is affected with acute lancinating pains, increased by 
the touch; the groins and thighs are likewise the seat of 
violent pain. Exudation of a tenacious, transparent, vis- 
cous, and acrid humour, whioh excoriates the labia pu- 
dendi, and occasions a swelling of them, as in metritis. 
Urine high-coloured and deficient in quantity, there is 
constipation, and the irritation often communicates itself 
to the rectum and bladder. 

Fits of coughing, sneezing, and vomiting, which shake 
the trunk, augment the pain. The sympathetic pheno- 
mena are numerous. Thus there is generally fever, which 
is rather slight, commencing with disorder of the stomach, 
malaise, alteration of the complexion, a bluish circle 
around the eyes, a tongue whitish in the middle and red 
upon the borders. 

Treatment. 
It should be entirely antiphlogistic, as in metritis. We 
should recommend the assiduous employment of baths, 
emollient lomentations, lavements, emollient applications 



56 THE PHYSIOLOGICAL 

to the sexual organs, mild, vegetable, easily digested diet, 
abstinence from spirituous liquors, from tea, coffee, from 
coitus, and from every thing that might have a tendency 
to excite lascivious ideas. 

When the treatment is well directed, the symptoms 
gradually diminish, and the disease generally terminates 
in twenty or thirty days. 

CHRONIC UTERINE CATARRH, FLUOR ALBUS, LEUC0RRH03A. 

Symptoms. 

Uterine catarrh much more frequently presents itself 
under the chronic form, even from the commencement, 
than under the acute; sometimes, however, it succeeds the 
acute state. 

If it has been preceded by the acute state, it retains a 
certain degree of heat, and of the acrid character. There 
is generally a sense of pain and lassitude in the legs and 
thighs. 

When it has not been preceded by the acute state, which 
is more generally the case, it is seldom that the flow is ac- 
companied with pains of the uterus or vagina. There is 
generally a sense of weariness, of weakness, and of sink- 
ing of the stomach. The eyes are surrounded by a dark 
circle, the tongue is whitish, and the appetite languid. 
Sometimes the discharge occurs two or three days before 
the catamenia, and terminates three or four days after 
them. At other times, on the contrary, it ceases on the 
appearance of the menstrual discharge, and reappears 
some days later; but in the course of time the discharge 
becomes habitual. Some women experience but little de- 
rangement of their digestive functions, others are not trou- 
bled with the disease but when they live in a heavy damp 
atmosphere. In general, chronic uterine catarrh has some 
relation to the skin; when the action of the latter is di- 



PRACTICE OF MEDICINE. 57 

minished, as occurs in cold and humid climates, that of 
the mucous membrane of the womb is increased, and vice 
versd. 

Persons of a lymphatic constitution, who have not in- 
dulged to excess in venery, and who have not had chil- 
dren, usually have fluor albus during the whole time that 
the menses continue, without suffering any inconvenience 
from it. 

Causes. 
The causes are generally the same as those of the acute 
variety. To these we may add the lymphatic tempera- 
ment; residence in large towns; the use of coffee with 
milk, as the experience of every day proves; a luxurious 
and indolent life. 

Nature of the Disease. 
Authors generally regard fluor albus as a sign of weak- 
ness: this is an error, for it often makes its appearance 
with the menses, a period at which the uterus enjoys its 
greatest activity, and also ceases with their termination, 
when the action of the uterus is diminished. When the 
catarrh continues, it is because the irritation of the uterus 
continues. Another proof is derived from the fact, that 
when uterine catarrh continues for a long time, it is not 
uncommon to see a chronic inflammation of the womb 
developed, with organic alteration, scirrhus, cancer, &c. 
Now, debility is not productive of such effects. 

Treatment. 

It varies with the primitive seat of the irritation, its 
intensity, and the constitution of the patient. 

If the catarrh is connected with disorder of the diges- 
tive function, wc must examine whether this derangement 
arises from irritation of the digestive organs, which will 



58 THE PHYSIOLOGICAL 

be indicated by redness of the edges of the tongue, and 
by the sensibility of the epigastrium; or whether there be 
real debility, a state which occurs in women who have 
been weakened by the prolonged and exclusive use of 
aqueous and mucilaginous substances. We recognise this 
state by the existence of cramps of the stomach, without 
redness of the tongue, or tenderness on pressure. In the 
former case the antiphlogistic treatment should be em- 
ployed, and even leeches applied to the epigastrium, if 
the irritation is by any means considerable. In the 
second case we prescribe more strengthening diet, light, 
bitter, and astringent infusions, slightly narcotic and as- 
tringent injections pervaginam. In every case, abstinence 
from coitus must be adhered to; this is an essential con- 
dition of the cure. When there is heat, pain, and sensi- 
bility in the uterus, and swelling of the neck of the organ, 
we must employ emollient injections, such as decoctions 
of mallows, of flaxseed, &c. Diluent drinks, a mild and 
vegetable diet, baths, emollient lavements, repose. Ab- 
stinence from wine, from spirituous liquors, from coffee 
and tea. 

If there is a want of action in the skin, and as a conse- 
quence increased activity of the mucous membrane of the 
uterus and vagina, we prescribe friction with a flannel 
impregnated with the vapour of aromatic plants, the use 
of woollen over the whole body; warm clothing; exercise; 
residence in the country in a dry climate; wholesome and 
abundant nourishment. However, if there are symptoms 
of gastric or of gastro-enteritic irritation, we treat them 
by appropriate measures, at the same time that we en- 
deavour to restore the action of the skin by the external 
applications which we have just described. 

In persons of a lively and irritable temperament, if the 
discharge is not accompanied with uterine pains, we first 
employ emollient injections of a decoction of mallows and 



PRACTICE OP MEDICINE. 59 

poppy, afterwards an infusion of the red rose and poppy, 
and finally, injections of astringent and tonic articles, prin- 
cipally of rhatany, pomegranate, catechu, tormentil, bis- 
tort. When there is no sensibility of the parts, a little 
aromatic wine, or a few drops of laudanum, may be added. 
In a word, when there is no sensible irritation, and the 
organs are flaccid, the use of tonics and astringents is in- 
dicated, and we should commence with the mildest arti- 
cles of these classes: when there is sensible irritation, 
emollients are necessary. 

A cure is sometimes obtained after having tried all 
other means without effect, by establishing a point of re- 
vulsion in the sacro-lumbar region by means of a large 
blister, which should not contain cantharides on account 
of the vicinity of the urinary organs. 

SEQUELS OF THE CHRONIC PHLEGMASIA OP THE UTE- 
RUS, ORGANIC ALTERATIONS, SCIRRHUS AND CANCER OF 
THE NECK OF THE WOMB. 

Prolonged irritation of the neck of the womb ultimately 
brings on disorganization; induration or scirrhus first oc- 
curs, and afterwards cancer. 

Symptoms. 

First degree. — Sensation of fulness in the pelvis, and 
of a weight which appears as though about to fall. Heat, 
pain in the groins and thighs, in the vagina, and about 
the neck of the bladder, cramps of the stomach, pale com- 
plexion. On touching, the neck is found painful, swelled, 
hard, and hot. Until ulceration occurs, it is uncommon 
for fever to exist. 

Second degree. — If this disease is not arrested, the 
neck of the uterus advances with more or less rapidity to- 
wards disorganization. Digestion is attended with pain, 



60 THE PHYSIOLOGICAL 

there is fever, a disgust for food, sometimes nausea and 
vomiting, frequency of pulse and exacerbation of fever 
towards evening, debility, lassitude, emaciation, pale, or 
rather pale sallow complexion. The pain is in proportion 
to the sensibility of individuals. Women whose sensibi- 
lity is obtuse, suffer little; they experience a sense of 
weight, and have a puriform, yellowish, or greenish dis- 
charge. Women of little sensibility may conceive, not- 
withstanding the presence of scirrhus. This is not the 
case with persons endowed with greater irritability. There 
are some whose sensibility is so acute that chronic inflam- 
mation of the neck of the uterus produces death before 
disorganization, the pain of which they are incapable of 
enduring, has occurred. 

The stomach and liver almost always contract irritation 
from the uterine affection: sometimes the lungs likewise 
participate, but more rarely. 

Constipation always accompanies this affection. 

Fever always indicates the existence of phlegmasia of 
the digestive organs, for it would not arise if the cancer 
existed alone and without complication. 

Cancer of the neck of the uterus often gives rise to co- 
pious uterine haemorrhages; in some it occasions purulent 
discharges intolerably fetid; or it may produce both these 
effects in the same person. Sometimes the cancer termi- 
nates in dropsy. Before death occurs, there is generally 
a deterioration of most of the functions; this is in conse- 
quence of the irritation having invaded most of the or- 
gans, and not on account of the cancer having communi- 
cated vicious qualities to the blood, as is taught by authors 
who give to this general state of deterioration the name 
of cancerous cachexy. 

Causes. 
All those of the phlegmasia? of the uterus, the continued 



PRACTICE OP MEDICINE. 61 

action of these causes, and principally a preceding phleg- 
masia, and the stimulating and incendiary means resorted 
to against these irritations. We must also recognise an 
organic predisposition to contract irritation. 

The proximate cause, or the nature of scirrhus, is easily 
conceived. The irritation, continued for a long time, 
eauses an afflux of fluids to the irritated part: there is, in 
consequence of this, super-nutrition, a deposit of albumen 
and other matters, a formation of foreign tissues in the 
midst of the parenchyma, which must necessarily become 
indurated; thus scirrhus is produced: the inflammation 
continues, or even passes to the acute state, and occasions 
ulceration of the engorged, swelled, indurated, or scirrhous 
parts, and this constitutes cancer. 

Prognosis. 

If the engorgement is red, soft, sensible, without alter- 
ation, there are hopes of cure; but if it is hard, insen- 
sible, yellowish or brownish, with a discharge of puru- 
lent matters, the prognosis is unfavourable. 

When ulceration exists in an engorgement of the first 
species, there is more hope than when it supervenes on 
an engorgement of the last kind. 

If the discharge is small, white, or of pure blood, not 
acrid, the prognosis is more favourable; it is ominous if 
the discharge is mucous, sanious, very fetid, acrid, puru- 
lent, abundant, corrosive. If at the same time the touch 
discovers an ulceration upon an indurated neck, there is 
but little hope. The yellow tint of the complexion is an 
unfavourable symptom, because it does not supervene 
except when disorganization is far advanced. 

Treatment. 
Variable, according to the progress and intensity of the 
disease. In women of robust and sanguine constitutions, 
9 



62 THE PHYSIOLOGICAL 

whose digestive functions are not yet impaired, and whose 
complexion is not sallow, we must employ the antiphlogis- 
tic treatment boldly and with perseverance; leeches to the 
number of twenty or thirty above the pubis, to the labia 
pudendi, to the perinseum. If we obtain a slight ameliora- 
tion after one or two applications, we repeat them with 
confidence every third or fourth day; but in smaller 
numbers, for example, ten or twelve, through the fear of 
prostrating the patient. We second the topical depletion 
by the continual employment of emollient cataplasms 
and fomentations. Ice applied to the sexual organs may 
also be advantageous. Severe regimen consisting in light 
and poor slops and some cooked fruits. Absolute rest 
Leaping, dancing, running, and all violent exercise are 
obstacles to the cure. For the same reason entire ab- 
stinence from venery must be enjoined. We discard as 
poison the anti-cancerous medicines so called, such as 
cicuta, the narcissus of the meadows, &c. 

If there is considerable induration of the neck, frequent 
bleeding would produce no effect, and would even be dan* 
gerous. The diet in this case must be less severe; we 
confine ourselves to the employment of cataplasms, of 
emollient injections, and local baths; leeches may be ap- 
plied when the pains are more acute. 

Revulsives may be useful in some cases. If the patient 
be of a lymphatic constitution, we may act upon the di- 
gestive canal by purgatives if it is in a healthy state. The 
sulphates of soda and magnesia, or the phosphate of soda in 
the dose of an ounce or an ounce and an half dissolved in 
a pint of water, constitute the most convenient purga- 
tives. One, two, or three glasses of this solution should 
be taken every day for several weeks in such a manner 
as constantly to keep up an easy evacuation of the bowels. 
We desist if symptoms of gastritis supervene; in this 
case the patient must be confined to emollients and to 



PRACTICE OF MEDICINE. 63 

the white and vegetable regimen. Emollient and narco- 
tic injections made with the root of mallows, with the 
poppy, or with the solanum nigrum. If there are fixed 
and obstinate pains in certain points of the abdomen, we 
employ emollient applications, and armed or dry cups 
according to the strength of the patient, or leeches. In 
women of an irritable constitution, we combat constipa- 
tion by emollient lavements, the use of watery fruits and 
fresh vegetables, but never by purgatives. If hsemorrhage 
occur from time to time, a farinaceous diet must be en- 
joined, and for drink, water acidulated with sulphuric acid, 
very light decoctions of rhatany, emollient and opiate in- 
jections, cold externally applied, if we have no apprehen- 
sion with regard to the thoracic organs. 

Finally, when all hope is lost, nothing remains but to 
palliate the pain; we employ opium in every way, com- 
bined with mucilaginous drinks, in frictions, in cataplasms, 
in lavements, and in baths. The discharge, which exco- 
riates the parts, must be wiped away, and a sponge should 
remain in the vagina to absorb it. From time to time, 
we cautiously employ opiate injections of melilot, of poppy, 
of mallows, of milk, &c. 

For some time past, the excision of the scirrhous or 
cancerous neck of the uterus has been practised with va- 
rious success. We must wait for more numerous expe- 
riments to judge of the utility of this bold operation, 
which cannot be attended with success, except when the 
disease is confined to the neck; extirpation of the whole 
uterus being a rash operation, although it has several times 
been attempted. 

PHLEGMASIA OF THE BODY OF THE UTERUS AND OVARIA, 
WITH ORGANIC ALTERATIONS OF THESE PARTS. 

The body of the uterus and its appendages are subject 
to many kinds of organic alterations. These alterations, 



64 THE PHYSIOLOGICAL 

whatever may be their form, have always for their proxi- 
mate cause an irritation or an inflammation of the parts 
which are their seat, or in other words, these alterations 
are constantly the result of an acute or chronic inflamma- 
tory process, preceding and accompanying them, which 
is sometimes almost imperceptible. 

The affection of the ovaria is more common than that 
of the body of the uterus. 

It is not always easy to determine precisely the seat 
of the disease, but this is of little importance in prac- 
tice, the essential thing is to know the degree of inflam- 
mation. 

Symptoms. 

To the touch the neck of the uterus is sound, but on 
applying the hand to the hypogastric region, a tumour., 
varying in size is perceived, which sometimes acquires 
such a magnitude as to produce the appearance of preg- 
nancy. We may then conjecture that the body of the 
uterus is the seat of the disease. If the tumour is felt on 
one side of the uterus, it is probable that one of the ova- 
ries is affected. 

These tumours often increase at eaeh menstrual period; 
they have been observed to descend even to the thighs, 
but these are extraordinary cases. They consist in an ex- 
cessive and unnatural development of the ovaria, or they 
form what is called a cyst of the ovarium. These encyst- 
ed tumours are more embarrassing than painful to the pa- 
tient. 

We may generally recognise the presence of a cyst by 
the fluctuation. But dissection alone can reveal the pre- 
cise nature of the alteration. The cysts are sometimes found 
filled with an albuminous matter; sometimes their con- 
tents are solid, resembling suet or yellowish grease, and 
we occasionally observe both these alterations existing 



PRACTICE OF MEDICINE. 65 

together; in these cases the fluctuation is more obscure 
than when the contents of the cysts are liquid. 

It is not uncommon for the diseased parts to form adhe- 
sions with the healthy. 

Prognosis. 

These alterations are of an alarming nature if the dis- 
ease is of long standing, but we may hope to discuss tu- 
mours of the uterus and ovaria when the malady is recent. 

In the case of cysts of the ovaria, of fibrous tumours 
of the uterus, of the development of fatty and lardaceo-us 
tissues, or of consecutive dropsy, there is no hope of cure. 

Treatment. 

By the treatment of the acute state we may prevent 
the supervention of the chronic. This treatment must be 
rigorously antiphlogistic. The application of leeches to 
the tumour, or the painful spot, frequently repeated; emol- 
lient cataplasms; douching the parts every four or five 
days, and following this operation with the application of 
eight or ten leeches; frequent baths, the internal use of 
the thermal waters, if the intestinal tube is sound. If 
there be a cyst, and very evident fluctuation, puncturing 
may be tried. 

When there is dropsy,^ dyspnoea, swelling of the legs, 
and a tumour of great magnitude, we can no longer em- 
ploy any other than a palliative treatment. It is then at 
the beginning that we must use strenuous endeavours to 
dissipate the irritation; for if we temporize, every kind of 
treatment usually becomes inefficient. In case an abscess 
is formed, its treatment is the same as that of other abscesses. 

When the tumour is considerable, we support it with 
an appropriate bandage. 

The pretended deobstruents only augment the irritation; 
they should be rejected. 



66 THE PHYSIOLOGICAL 

A revulsive medication is not unworthy of our atten- 
tion. This consists of light purgatives, if the intestinal 
tube is healthy, dry or aromatic frictions, the frequent ap- 
plication of cups in the neighbourhood of the tumour, 
douching. 

The success which I have obtained from the employ- 
ment of galvanic electricity in certain cases of engorge- 
ment of the thyroid gland, and of the mammary and lym- 
phatic glands, favour the presumption of the efficacy of 
this means in engorgement of the ovaria and the womb, 
and particularly in the commencement of these affections. 

To direct a galvanic current upon the body of the ute- 
rus in this manner, make one of the poles communicate 
with the neck of the uterus through a tube of glass, of the 
form of a speculum uteri, to insulate the conductor, and 
make the other pole communicate with the tumour. In 
the case of diseased ovaria, the two poles are to be placed 
in opposition on the points of the tumour most remote 
from each other. The voltaic pile may be used every day, 
or even twice a day, for the space of twenty, thirty, or 
forty minutes, or even an hour. 

IRRITATIONS AND INFLAMMATIONS OF THE GENITAL AP- 
PARATUS OF MAN. 

INFLAMMATION OF THE URETHRA. 

In the greater number of cases this disease is of vene- 
real origin. 

It is generally characterized by pain of different degrees 
of intensity, during the passage of the urine, and by a dis- 
charge of a whitish matter: it is then named blennor- 
rhagy. This discharge is the result of an excess of action 
existing in the mucous membrane of the canal. It bears 
the same relation to this canal that nasal catarrh or coryza 
does to the mucous membrane of the nose. 



PRACTICE OP MEDICINE. 67 

Whether there exists a discharge or not, the duty of 
the physician is to give his whole attention to the inflam- 
mation or irritation itself. Whether the irritation of the 
canal of the urethra, with or without blennorrhagy, is de- 
rived from a syphilitic source, or has a different origin, 
the nature of the irritation is always the same, and exacts 
the same treatment. It is either acute or chronic. When 
acute, it is often accompanied by pain of no little inten- 
sity. When chronic, it is seldom or never painful ; and 
it only manifests itself by a mucous, lactiform discharge, 
which seldom assumes a purulent appearance. As a se- 
quel, the mucous membrane sometimes becomes thicken- 
ed, giving rise to contractions of the canal. 

Treatment of Acute Inflammation of the Urethra — 
Acute Blennorrhagy. 
To prevent the communication of inflammation to the 
bladder, to the testicles, or to the inguinal glands, we 
must commence the treatment by the application of 
twenty or thirty leeches to the perinseum and to the root 
of the penis, and likewise apply three or four over the 
course of the urethra; the bites are to be covered by an 
emollient cataplasm. We must second this first medica- 
tion by a treatment rigorously antiphlogistic, by emollient 
drinks slightly medicated with nitre, frequent warm bath- 
ing, lavements, vegetable diet, and rest: for it is certain 
that walking, riding, and dancing, keep up the inflamma- 
tion and retard the cure. If the pain is insupportable, the 
part may be bathed two or three times a day in a decoc- 
tion of mallows or of poppies. Neither wine, alcoholic 
drinks, coffee, nor tea, arc to be allowed; total abstinence 
from venery is to be enjoined. What shall we say of bal- 
sam copaiba, of cubebs, of drastic purgatives, &c. It is 
true these medicines sometimes remove blennorrhagy in 
a very short time, often in the course of six or eight days. 



68 THE PHYSIOLOGICAL 

Yet none but charlatans can recommend the use of them. 
The physiological physician, who is aware that they only 
act as revulsives, and by actively irritating the digestive 
canal, and inviting thither the urethral irritation, will re- 
sort to them with the greatest reserve, and only in cases 
in which there is a total absence of irritation in the intes- 
tinal canal. In every case, we risk the exchange of an 
irritation of little importance, which always yields to the 
treatment pointed out, if pursued with care and perse- 
verance, for a gastritis, an enteritis, or a colitis. The spe- 
cifics of empiricism so much vaunted, and which find 
dupes to use them still more numerous than knaves to 
sell them, owe their properties to some one of the irritat- 
ing substances of which we have been speaking, or to 
others analogous to them. 

Treatment of Chronic Inflammation of the Urethra — 
Chronic Blennorrhagy. 
The treatment of this disease varies according as the 
preceding blennorrhagy has been treated by antiphlogis- 
tics, or has been kept up and exasperated by stimulants, 
balsam copaiba, cubebs, purgatives, &c. In the first case, 
when the prolonged use of antiphlogistics has failed, we 
must continue the treatment, and in addition, make use 
of injections; not, however, beginning abruptly with the 
most astringent, as is often done, but by gradually ascer- 
taining the sensibility of the canal. We commence then 
the first day by injecting cold water; the next day we em- 
ploy a solution of sugar in water;, we then resort to a so- 
lution of sugar in wine and water, and afterwards in pure 
wine. At a more advanced stage of the treatment we em- 
ploy the decoction of rhatany, which we render more 
strong as we advance: two drachms of the extract of rha- 
tany to a pound of water constitute a very good propor- 
tion. Finally, we come to injections of the sulphate of 



PRACTICE OP MEDICINE. 69 

zinc, the sulphate of alumine, the acetate of lead. But it 
is rarely the case that blennorrhagy does not yield to the 
employment of injections made with substances contain- 
ing tannin. The discharge having been arrested, we con- 
tinue the injections, following an order the inverse of that 
with which we commenced, descending by degrees to the 
less astringent, until we return to pure water. We repeat 
the injections five or six times during the day. In the se- 
cond case, that is, when the blennorrhagy has been exas- 
perated by stimulants, we commence by employing the 
same treatment as for the acute stage. This treatment 
often succeeds; if it do not, and we can obtain the con- 
sent of the patient, we should apply a blister to the peri- 
nseum, or high up on the thighs, to operate a revulsion, at 
the same time continuing the antiphlogistic treatment. If 
this mode is unsuccessful, injections should be employed 
as in the preceding case. In every case in which injec- 
tions are used in the manner pointed out, their adminis- 
tration should be suspended the instant that symptoms of 
the acute stage supervene, and we perceive that they aug- 
ment instead of diminishing the irritation. 

Violent exercise, dancing, spirituous drinks, tea, coffee, 
heating aliment, and venery are to be interdicted as ri- 
gorously as in the acute stage. 

INFLAMMATION OP THE TESTICLE; VENEREAL TESTICLE. 

Organic Alterations which result from it. 
The testicle receives irritation through a diversity of 
channels. The most ordinary causes are irritations of the 
canal of the urethra, which often involve the testicle. It 
is incorrectly said in these cases that the blennorrhagy 
has fallen upon the testicles; the irritation having become 
predominant in the testicles, it appears to have abandoned, 
and often in reality abandons the canal of the urethra. It 
10 



70 THE PHYSIOLOGICAL 

is then a metastasis, and nothing more. The name of 
venereal testicle, which has been given to it in this case, 
signifies nothing, this inflammation being of the same na- 
ture as that arising under any other circumstances. The 
other causes of this affection are falls, contusions, pressure 
produced by the clothes, equitation, activity of the semi- 
nal secretion, when there is no evacuation of it, or emis- 
sions of semen too frequently provoked and dispropor- 
tionate to its secretion. Inflammation of the testicle is 
acute or chronic. 

Symptoms of Acute Inflammation. 
Under the influence of the preceding causes, the testicle 
becomes hot, painful, and swelled, and acquires, some- 
times in a very short time, a considerable development. 
If we do not promptly attack the disease, it ordinarily 
becomes chronic, and it is important to prevent this 
result. 

Symptoms of Chronic Inflammation. 
The tumour may remain for a certain time stationary, 
and often there is only a simple engorgement, unattended 
by any organic alteration, or any considerable pain. Yet 
if we do not arrest the irritation, the tunica vaginalis be- 
comes thickened, and the exterior cellular tissue harden- 
ed; the testicle continues to grow large and indurated, 
particularly towards the epididymis: this constitutes 
sarcocele. At other times, the secretion of an albuminous 
serosity, more or less abundant, takes place, the result of 
inflammation of the tunica vaginalis; this is hydrocele. 
Sarcocele and hydrocele sometimes exist simultaneously. 
Cancer, scirrhus, suppuration, ulceration, &c. are likewise 
results of the chronic inflammation of the testicles. 



PRACTICE OF MEDICINE. 71 

Treatment of Acute Inflammation. 
Irritation of the testicle being identical in its nature, 
whether its origin be venereal or not, the treatment does 
not vary. When the testicle becomes hot, swelled, and 
painful, it is necessary to attack the disease. The treat- 
ment will consist of rest; the horizontal position; confine- 
ment to bed, as far as possible; the use of the suspensory 
truss; an emollient cataplasm to the diseased part; frequent 
warm baths; the application of leeches to the testicles, 
varying in number from ten to forty, according to the 
sensibility and strength of the individual. By these means 
we remove in a short time the acute inflammation of the 
testicle, which, in every case may assume a very serious 
aspect. We persevere for some time in the use of emol- 
lients, even when the inflammation has been subdued. In 
this manner we prevent hydrocele, sarcocele, and other 
organic alterations. Ice has sometimes been used with 
success, but very irritable persons cannot endure the 
application. 

Treatment of Chronic Inflammation. 

When the malady is decidedly chronic, a state that is 
often derived from the ill-timed use of discutient appli- 
cations, such as the acetate of lead, vinegar, the plaster of 
vigo, &c; if organic alteration has not yet occurred, we 
can have recourse to the antiphlogistic treatment indi- 
cated above; numerous cures daily demonstrate its advan- 
tage ; but the patient should be informed that the cure is 
slow, and that a persevering use of the means is necessary. 
Douches to the parts, followed by the application of eight 
or ten leeches, once, twice, or three times a week, have 
sometimes succeeded when all other means have failed. 

After the prolonged use of antiphlogistics, when the 
irritation has been subdued, we may hasten the resolu- 
tion of the tumour by the employment of discutient ap- 



72 THE PHYSIOLOGICAL 

plications, whatever may be the cause of the disease. 
Frictions upon the scrotum with a little mercurial oint- 
ment, or with calomel moistened with saliva, the appli- 
cation of compresses wet with vinegar and water, or with 
a weak solution of the acetate of lead, or of the deuto- 
chloride of mercury. We must essay successively these 
various means, and not persevere in their use unless when 
we derive from them, in a reasonable length of time, some 
decided advantage. Mercurial frictions may likewise be 
employed on the internal face of the thighs. Abstinence 
from stimulating food and drinks, from venery, rest, the 
use of the suspensory bandage, the warm bath. This 
treatment is to be continued several days after the cure 
seems confirmed. 

When the treatment has not been successful, and the 
testicle is hard, affected with lancinating pain, or is scirr- 
hous or cancerous, we practice extirpation, but we are 
not driven to this extremity, until we have exhausted the 
antiphlogistic treatment. In the case of hydrocele, we 
practice the puncture. 

Sudorifics may be used, such as the sarsaparilla and 
others, and gentle purgatives may be employed with pru- 
dence, after the antiphlogistic treatment, if the digestive 
canal is sound. 

ABDOMINAL PHLEGMON. 

This is an inflammation of the cellular tissue which ex- 
ists between the muscles and the peritonaeum, and between 
the duplicatures of the great epiploon, in the gastro-hepa- 
tic epiploon, in the mesentery, around the colon, on the 
flanks, around the kidneys, in the iliac fossa; all these 
points may be the seats of an inflammation. 

Symptoms. 
The general signs of phlegmon : the pulse large, full, 



PRACTICE OF MEDICINE. 73 

frequent, and not contracted, as in the inflammations of the 
intestinal mucous and serous membranes. If the disease 
advances, there is fever resembling the inflammatory 
fever. 

The existence of phlegmonous inflammation having been 
ascertained, where is it situated? If the phlegmon exists 
about the liver or the right side, the part will be hot and 
renitent, but the absence of the symptoms of hepatitis or 
gastritis will distinguish it from those affections. In the 
pelvic basin, it interferes with the functions of the viscera 
in its vicinity. When the epigastric region is the seat of 
it, there is redness of the tongue, an impossibility of 
swallowing, but there is appetite and an absence of the 
sympathies that indicate gastritis. 

When in the epiploon, we sometimes perceive a pain- 
ful swelling in the parietes of the abdomen; but the pulse 
is not small and contracted, as in peritonitis. It is diffi- 
cult, not to say impossible, to distinguish phlegmon of the 
mesentery from enteritis. 

Causes. 
Falls, blows, inflammation of the contiguous viscera, 
and of the fibrous locomotive system communicated to 
the cellular tissue, the repercussion of the psoric affections^, 
irritants applied to the skin, a particular individual pre- 
disposition. 



It is of importance to arrest promptly this phlegmasia, 
which is not less dangerous than acute peritonitis or gas- 
tritis. It may produce suppuration in a short time; the 
pus diffuses itself, is absorbed, and the patient falls into 
a state of putridity and colliquation. On an examination 
of the body after death, we meet with vast abscesses, and 
other important organic disorders. If the phlegmon passes 



74 THE PHYSIOLOGICAL 

into the chronic state, the abdominal viscera suffer from 
compression, and there is generally a complication of gas- 
troenteritis and pneumonia; marasmus supervenes, and 
death releases the patient from his sufferings. 

Treatment. 

In the acute stage, general bleeding, assisted by the ap- 
plication of alarge number of leeches over the affected parts, 
as in peritonitis. (See Peritonitis.) To cover the bites 
with large emollient cataplasms, rest, confinement to bed, 
a diet more or less rigid, according to the intensity of the 
inflammation; to continue the use of those means for some 
time, even after the malady has begun to assume a chronic 
form. 

If the antiphlogistic treatment proves ineffectual, and 
the disease remains stationary, we must employ revulsives: 
dry frictions; mercurial frictions; vesicatories; the moxa, 
placed at a little distance from the diseased point; sudo- 
rific drinks, if the digestive organs are in a sound state; 
warm baths; douches; mineral waters of an aperient na- 
ture. All internal stimulants are to be abandoned the mo- 
ment symptoms of gastritis, or of gastro-enteritis make 
their appearance. 

INFLAMMATORY IRRITATIONS 

OF THE MUCOUS MEMBRANE OF THE PECTORAL VISCERA 
AND THEIR CONNEXIONS: — OF THE NOSE, THE EAR, THE 
EYE, THE MOUTH, THE VELUM OF THE PALATE, THE 
TONSILS, THE PHARYNX, &C. 

After the irritations of the abdominal viscera, it is pro- 
per to treat of those of the viscera of the chest, on ac- 
count of the close connexion between them. 



PRACTICE OP MEDICINE. 75 

External irritations often give rise to those of the chest, 
as we have seen with regard to the intestinal tube. 

It is proper to commence the history of the phlegmasia? 
of the chest with those of the mucous membrane of the 
nose, the ear, the mouth, the larynx, because the irritation 
of the lungs often commences in them, on account of the 
continuity of the mucous membrane. 

The general causes of irritation of the mucous mem- 
brane of the pectoral viscera, are: — 

1. Cold: it suppresses the action of the skin, which re- 
produces itself on the membranes in question. 

2. The sudden suppression of the cutaneous transpira- 
tion, or of an issue. 

3. The action of air more or less heated, more or less 
charged with gas or irritating vapours. 

4. Modifications produced by natural stimulants. The 
phlegmasia? of the intestinal mucous membrane repeats 
itself on that of these viscera. 

5. A particular organic disposition, rendering these or- 
gans more apt to take on irritation. 

IRRITATIONS OF THE NASAL MUCOUS MEMBRANE. 

CORYZA. 

Irritation of the mucous membrane lining the nasal 
passages is denominated coryza. It may present itself in 
various degrees. It corresponds in intensity with the 
causes that produce it, and the inflammatory predisposition 
of the subject. 

Symptoms. 
A sensation of weight in the frontal region, watering 
of the eyes, there is pain above and below the orbits, re- 
spiration by the nose is difficult or impossible; there is 
a discharge of an acrid mucosity from the nostrils, which 



76 THE PHYSIOLOGICAL 

irritates the skin and the lips; the sense of smell is totally- 
suppressed, or nearly so; sneezing, or the desire to sneeze. 

This irritation may be communicated to the mucous 
membrane of the lungs, and give rise to pulmonary ca- 
tarrh. It is sometimes known to assail the maxillary sinus, 
and determine there a collection of mucous or purulent 
secretions. 

Coryza may become chronic, especially if the cause is 
permanent. 

Causes. 
The most frequent are vicissitudes of heat and cold; 
cold to the feet; the sudden suppression of the cutaneous 
transpiration; gases and irritating vapours; falls; external 
violence; the introduction of irritating bodies into the 
nasal passages. 

Prognosis. 
Coryza alone, owing its origin to an external cause, is 
an affection of little importance ; but, if it is connected 
with a pulmonary or cerebral affection, the danger will be 
in consequence of the intensity of this latter affection. 

Treatment. 

The most important part of the treatment consists in 
the avoidance of cold, particularly that of the feet. The 
use of demulcent drinks is sufficient to dissipate this irri- 
tation in the greatest number of cases. 

In case of a very violent coryza, one or two leeches 
may be applied to the orifices of the nose, particularly if 
a pulmonary catarrh be apprehended. 

If there is danger of a cerebral congestion, besides the 
leeches, we practice a general bleeding. In one word, 
the complication and extent of the irritation must deter- 
mine the treatment in this as in all other cases. 



PRACTICE OF MEDICINE. 77 



PHLEGMASIA OF THE ORGANS OF HEARING. 

OTITIS. 

The mucous membrane which lines the interior of the 
.ear, is subject to inflammation. This inflammation is called 
otitis. It is acute or chronic. 

Symptoms. 
They bear a relation to the intensity of the inflamma- 
tion; if this is very intense, the least noise is insupporta- 
ble, and the least agitation of the air reverberates through 
the whole head. An exaltation of the sense of hearing, 
pulsatile pain, sometimes so intense that it banishes sleep, 
and renders the patient almost furious. There are heat 
and swelling around the external ear; the pain sometimes 
extends to the posterior parts of the mouth, through the 
Eustachian tube. This inflammation never gives rise to 
fever, unless it be complicated with other phlegmasia?. If 
the external auditory meatus is inflamed, there is exalted 
sensibility of the part and a buzzing in the ear, but the 
pain is not equally intense; there is a little deafness and a 
discharge of mucosities. 

Causes. 

The natural stimulus of the ear is sound, when too loud 
it may occasion inflammation. 

Cold may determine it in two manners, by the exter- 
nal auditory canal, and by the Eustachian tube, which 
likewise may become irritated from the extension to it of 
the irritation of the mucous membrane of the nose, of the 
mouth, or of the pharynx, &c. 

Then follow in the list of causes, external violence, the 
suppression of the cutaneous transpiration, of the itch, of 
11 



78 THE PHYSIOLOGICAL 

the tetter, of rheumatism, of an issue, of the gout, of a 
haemorrhage, &c. It may be produced by an inflammation 
of the brain, and vice versd. 

Prognosis. 
It may be promptly cured, if the treatment be com- 
menced in proper time; but if the malady has become 
chronic, if there is suppuration, it is to be presumed that 
the disease will be tedious. When there is a discharge of 
pus with carious bones, the disease is profound, and we 
may apprehend the loss of hearing, and in the sequel, or- 
ganic alterations. However, we cannot establish a very 
decided prognosis, for there are sometimes persons who 
live a very long time with an otitis; in others, a fatal ter- 
mination soon occurs, in consequence of inflammation of 
the brain. If the inflammation is very violent, there is al- 
ways some danger. 

Treatment. 

In the acute stage, the application of twenty to fifty 
leeches around the ear; a repetition of this means if the 
inflammation continues; warm emollient injections; by this 
treatment the disease is subdued in three or four days. If 
the inflammation is slight, and is confined to the external 
auditory meatus, repeated emollient injections will be suf- 
ficient. Rest and the absence of noise. 

If the disease is of some continuance, we must employ 
revulsives; a blister to the neck; pediluvia with water 
rendered stimulant with mustard. If the inflammation re- 
sume the acute state, we resort to local bleeding, as in the 
preceding case. 

If deafness be the result of the suppression of a haemor- 
rhagy, of the tetter, or of the itch, &c. the irritation must 
be recalled to its first seat by appropriate stimulants. 
Leeches often cure deafness depending upon these causes. 



PRACTICE OF MEDICINE. 79 

If there be a complication of encephalitis, of gastritis, 
&c. we combat these affections by the means usually re- 
sorted to in those diseases. 



PHLEGMASIA OF THE ORGANS OF SIGHT. 

OPHTHALMITIS. 

Irritation of the mucous membrane of the eyes is closely 
allied to that of the mucous membrane of the mouth and 
nose, on account of the relation that exists between these 
tissues. This irritation is called ophthalmia. Ophthalmia 
has its seat in the conjunctiva, in the margin of the eyelids, 
or it affects the globe of the eye. It is chronic or acute. 

Symptoms. 

Redness of the conjunctiva; the sensation of a grain of 
sandorany other irritating body on this membrane; pain va- 
rying in intensity; a watering of the eyes; difficulty or inca- 
pacity of bearing the light. If the inflammation occupies 
the margins of the eyelids, to the preceding symptoms are 
joined redness and swelling of the tarsi cartilages; some- 
times there is a secretion of whitish or yellowish matter, 
which glues the eyelids together, and prevents the patient 
from opening his eyes, especially on awaking in the 
morning. 

If the inflammation becomes phlegmonous, it occupies 
the whole globe of the eye, and the swelling is more con- 
siderable than in simple ophthalmia of the conjunctiva. 
The view is completely obscured; the pain is most in- 
tense; fever often makes its appearance, varying in inten- 
sity with the inflammation and the irritability of the pa- 
tient. 

Most frequently both eyes are affected ; however, the 
inflammation sometimes attacks but one eye, and after it 



80 THE PHYSIOLOGICAL 

has continued to occupy it for some time, the other is of- 
ten affected by sympathy; or the inflammation ceases in 
the one to transfer itself to the other. 

The course of this phlegmasia depends on the causes 
which have produced it, or which keep it up, and upon 
the constitution of the individual. 

It may extend to the brain and give rise to encephalitis. 
It may thicken the cornea, and render opaque the hu- 
mours of the eye; for, if the irritation is communicated to 
the organs charged with the secretion of these humours, 
the nature of the secretions must necessarily be changed. 

Sometimes the crystalline lens alone becomes opaque, 
constituting cataract. Every kind of organic inflammation 
may be the result of this inflammation: spots of the cor- 
nea, scirrhus, cancer, staphyloma, glaucoma, hydroph- 
thalmia, &c. 

If the cause is venereal, organic disease much more rea- 
dily occurs. 

It is often the case that the nasal duct participates in 
the inflammation, the mucous membrane becomes thicken- 
ed, and there results fistula lachrymalis, epiphora. 

Causes. 
Too intense a light; long-continued reading at night or 
in the sun; external violence; foreign substances introduc- 
ed into the eye; acrid vapours; irritation of the mucous 
membrane of the nose extending itself to the eye; inflam- 
mation of the brain, that of the gastric passages, and, by 
consequence, the causes of those affections; depressing 
passions; grief; prolonged weeping; the metastasis of an 
irritation to the eyes. In this last cause is comprised the 
suppression of a cutaneous eruption, of an haemorrhage, 
of an issue. The measles, the small-pox, and very fre- 
quently the scrofulous affection, the venereal pus. 



PRACTICE OF MEDICINE. 81 

Treatment. 

If the inflammation is acute, the application of twenty, 
thirty, or forty leeches about the temples. It is very dan- 
gerous to apply them, as some physicians advise, to the 
conjunctiva, as the b'tes may determine a violent inflam- 
mation, the consequences of which are always unhappy. 
Cold emollient fomentations of the decoction of mallows 
or of flaxseed. No cataplasms. If the irritation be not very 
intense, the application of cold to the eye, continued during 
several successive hours. The exclusion of light; pediluvia 
with water containing mustard; demulcent drinks; glys- 
ters to keep the bowels open, or mild laxatives if the di- 
gestive organs are sound; diet more or less severe, accord- 
ing as there is fever, or the local inflammation be more or 
less intense. If there exists plethora, and particularly if 
the inflammation be phlegmonous, at first a general bleed- 
ing, afterwards local bleeding, often repeated to prevent 
organic alterations. This precept is to be rigorously en- 
forced in every case, but more especially when the oph- 
thalmia has a venereal origin. 

In the chronic stage, after the inflammation has even 
existed for some months, we may use moderate topical 
depletion, and repeat it from time to time, adding to it 
the treatment pointed out below. 

After the employment of antiphlogistics, if the irrita- 
tion continues, and remains stationary, we make trial of 
the astringent collyria, which are most suitable when the 
vessels become varicose and there is but little pain. 

We employ for this purpose solutions of the sulphate 
of zinc or the sub-acetate of lead, containing a small quan- 
tity of opium, the clarified decoctions of the substances 
containing tannin, such as galls, bistort, tormentil, &c. An 
ointment may also be employed made with the sulphate 
of alumine, or the white of an egg and alcohol beaten up 



82 THE PHYSIOLOGICAL 

together. We suspend the employment of astringents if 
they increase the irritation. In chronic palpebral ophthal- 
mia, we often obtain very good effects from frequent fo- 
mentations with water made as hot as the eyelids can bear 
it. We also attack these rebellious palpebral irritations 
with astringents, and even with cauterization with the ni- 
trate of silver or the butter of antimony. 

When ophthalmia has left a certain opacity of the eye, 
we sometimes succeed in dissipating it by antiphlogistics 
and cold emollient fomentations; if this does not succeed, 
we blow into the eye the oxide of zinc, sugar candy, and 
the proto-chloride of mercury, reduced to an impalpable 
powder. To conclude, we must feel our way, employ 
now one remedy, and then another, be governed by the 
susceptibility of the diseased parts, and suspend our treat- 
ment if the irritation appears to be exasperated. Revul- 
sion is one of the most powerful means of treatment in 
chronic ophthalmia; we can pursue it in connexion with 
the antiphlogistic treatment. When every thing has failed, 
it often yields to a large blister, and particularly to a se- 
ton in the neck, a remedy that we cannot too strongly re- 
commend. 

The syphilitic complication should be treated by means 
appropriate to the nature of the disease. 

The scrofulous disposition should be combated by the 
means pointed out, (see Scrofula;) but ophthalmia derived 
from this cause does not require a peculiar treatment. 
Antiphlogistics and topical bleeding in the acute stage are 
to be resorted to; in the chronic, antiphlogistics and re- 
vulsives, particularly the seton; these means with astrin- 
gents, constitute the whole treatment. 

Complications of gastritis, of encephalitis, &c. must be 
treated with more or less energy according to their in- 
tensity. (See Gastritis and Encephalitis.) 

Organic alterations require surgical treatment, an ac- 



PRACTICE OP MEDICINE. 83 

count of which cannot be given here; but we may remark 
that these alterations would be prevented in almost every 
case, if we would vigorously attack ophthalmy in its com- 
mencement with the antiphlogistic treatment and with 
blood-letting. How many evils does the unseasonable em- 
ployment of astringents produce, particularly in the acute 
stage! If they do not arrest the inflammation, they al- 
ways determine a vital reaction, which exasperates it; 
either curing the disease, or giving it redoubled energy. 
The prudent physician will not therefore use them unless 
where there is no fear of reaction; that is, when the in- 
flammation is slight or chronic. 

PHLEGMASIA OF THE PARIETES OF THE MOUTH. 

FLUXION. 

We give the name of fluxion to the inflammation which 
sometimes develops itself in the cheek. The ordinary 
cause of this inflammation is cold: however, a phlegmasia 
primitively seated in the mucous membrane of the mouth, 
may by contiguity assail the cheek. Caries of the teeth 
often produces a violent inflammation, which resembles 
erysipelas. This accident occurs most frequently when 
cold concurs with this cause. The result of this inflam- 
mation is sometimes an abscess, which opens into the 
mouth; in other cases, the inflammation becomes chronic, 
and hence result stagnation of lymph, a deterioration of 
the teeth and gums, neuralgia, &c. 

We must commence early with the treatment of this 
inflammation. We remove it by the antiphlogistics, by 
leeches applied internally to the commisures of the cheeks 
and gums, without being deterred by the temporary swel- 
ling which they determine. If the fluxion is produced by 
the caries of a tooth, we have it extracted; if by the accu- 
mulation of tartar, the teeth must be cleaned. 



84 THE PHYSIOLOGICAL 



PHLEGMASIA OF THE GUMS. 

GENGIVITIS. 

The gums are frequently the seat of inflammation. In 
general there is too great a propensity to give the name 
of scurvy to irritations of the gums, which for the most 
part are of an ordinary nature. 

Symptoms. 
The gums are of a deep-red or livid colour, swelled, 
and painful; sometimes this swelling is accompanied with 
little ulcerations. The mucus becomes deteriorated, it 
exhales a fetid odour; a bloody fluid oozes out on the 
least pressure. All this may exist without any scorbutic 
affection. 

Causes. 
Cold, the use of poor, salted, or spiced provisions; 
drinks too hot or too cold; the use of tobacco in smoking 
or chewing; violent friction; irritating acid dentifrices; a 
peculiar predisposition to contract this inflammation. 

Treatment. 

When the inflammation is acute, if the tissues are not 
gangrenous, and do not fall into shreds, we employ the 
antiphlogistic treatment. The application of leeches to 
the angles of the jaws, sometimes in the interior of the 
mouth to the gums; emollient gargarism with honey water, 
with milk and water, with the decoction of mallows, &c. 

A light diet of vegetables, and requiring no effort of 
mastication. When the heat of the mouth has diminish- 
ed and the inflammation abated, recourse may be had to 
gargles acidulated with muriatic acid, to astringent decoc- 



PRACTICE OP MEDICINE. 85 

tions made with tormentil, the bistort, rhatany, pomegra- 
nate, &c. If the antiscorbutics are used, such as the coch- 
learia, cresses, the aromatic wine, we generally exasperate 
the inflammation. We must abstain from this treatment, 
particularly during the acute stage. 

Gastritis often accompanies this inflammation; we must 
then employ the treatment indicated by this complication. 
(See Gastritis.) The antiscorbutics may be employed 
when there really exists scurvy, not complicated with 
gastritis. 

APHTHA. 

The disease called aphthae consists in little whitish ul- 
cerations with red margins, which make their appearance 
in the interior of the mouth, on the palate, upon the gums, 
upon the borders of the tongue, upon the velum palati, 
and upon the internal surfaces of the cheeks. 

Symptoms. 
We first perceive little miliary eruptions upon diverse 
points of the mucous membrane of the mouth and of the 
tongue, with a red areola, and covered with grayish 
crusts. Profuse salivation, sometimes a swelling of the 
salivary glands. There is no fever, unless there be a com- 
plication of gastritis, which is not a rare occurrence, (this 
is the mucous fever of authors.) Infants arc often aifect- 
ed with this complaint; they cry, refuse to take the breast, 
and if the affection is of long duration, they fall into ma- 
rasmus, and rapidly succumb. 

Causes. 
The lymphatic temperament predisposes to it: the oc- 
casional causes are the same as those of other inflamma- 
tions of the mouth. In infants this affection is ordinarily 
12 






86 THE PHYSIOLOGICAL 

occasioned by dentition, by bad nourishment, or by an 
unhealthy habitation. 

Aphthae have been divided into the benign, the malig- 
nant, the putrid ; but there is no distinction to be established 
except according to the degree of inflammation. Aphthae 
are here only to be considered as a disease of the mouth, 
the other inflammations which may be connected with it 
are to be regarded by us as foreign complications. 

Prognosis. 
The prognosis, in the case of infants, is unfavourable 
when the disease is of long continuance. It is exceed- 
ingly unfavourable when there exists with it violent 
fever, when there supervenes symptoms of adynamy or 
ataxy, a circumstance which always announces some im- 
portant complication, principally of the cerebral and di- 
gestive organs. When this phlegmasia is confined to the 
mouth, it is attended with little danger. 

Treatment. 
In infants, on the first appearance of the disease, we 
should attack it by the application of leeches under the 
chin and to the angles of the jaws, and by emollient in- 
jections into the mouth. When the inflammation has been 
moderated, we touch the aphthae wih a dossil of lint dip- 
ped in water rendered slightly pungent by sulphuric, mu- 
riatic, or nitric acid, or by vinegar. If there is heat about 
the epigastric region, or inflammation of the colon, ordi- 
narily indicated by diarrhoea, we employ antiphlogistics 
over the diseased parts. When the disease occurs among 
adults, the treatment should be nearly the same; topical 
blood-letting more profuse; gargarisms, at first emollient, 
then slightly acidulated; cauterization. By these means 
we often prevent the irritation from extending to the 
interior. 



PRACTICE OP MEDICINE. 87 

If aphthae commences violently; if there are black gan- 
grenous spots; acute pain; a complication with pneumonia, 
angina, or gastro-enteritis, our dependance is still to be 
placed on the antiphlogistic treatment; but when there 
exist signs of gangrene, of adynamy, or of ataxy, we 
must beware of employing depletion, and confine ourselves 
to the use of demulcents, which are the only means we 
can employ, although with them our success is very un- 
certain; this however is owing to the serious nature of the 
inflammation. Tonics and stimulants only accelerate the 
progress. We may, however, employ them, by commenc- 
ing with the mildest, but this is only allowable when the 
inflammation has abated. 

PHLEGMASIA OF THE VELTTM PALATI, OP THE TON- 
SILS, AND OF THE UVULA. 

ANGINA TONSILLARIS. 

The phlegmasia? of these parts bear the name of angina, 
because they impede respiration and deglutition. 

It presents itself under divers forms. 1st. The acute 
form, arising from the ordinary causes of inflammation. 
2d. The chronic form. 3d. The malignant and gangre- 
nous form. 

Symptoms of Acute Angina Tonsillaris. 
Pain; heat of the pharynx; difficulty of deglutition; a 
bright redness of the velum palati; a swelling more or less 
considerable of one or both tonsils; thirst more or less 
urgent. If the malady is not arrested, general symptoms 
manifest themselves; the pulse is frequent; there is often 
complication with gastritis; in this case the tongue is yel- 
low, clammy; there is some fever, with general uneasi- 
ness and nausea. This is the angina which has been 



88 THE PHYSIOLOGICAL 

called bilious, while the name of inflammatory has been 
reserved for acute angina, without complication of gastri- 
tis. This distinction is erroneous, for both are inflam- 
matory, but the one is simple and the other complicated. 
It may be phlegmonous, and advance rapidly to suppura- 
tion; this often occurs when the tonsils are much swelled 
and painful, and there is no gastritis. 

As soon as the pus is evacuated the pain ceases, and 
the fever is dissipated; this proves that it was kept up by 
the local irritation, if indeed there be no complication 
with another phlegmasia. 

Sometimes it exists simultaneously with measles, with 
the small-pox, or with scarlatina. Sometimes the swell- 
ing is so considerable as to threaten suffocation, and it 
may, in fact, occasion death, if the disease advances ra- 
pidly, and is not promptly arrested. It is, however, to 
be observed, that such a termination is rare. 

Symptoms of Chronic Jlngina Tonsillaris. 
The inflammatory swelling, the redness, the heat and 
the pain are less than in the acute stage. Sometimes the 
structure of the glands undergo a degeneration, and be- 
come thickened, scirrhous, or ulcerated. These alterations 
are the effect of inflammation. More frequently chronic 
angina is kept up by a slight gastritis, by a syphilitic 
cause, or by an irritation purely local. We see persons 
for many years the subjects of chronic inflammation of 
the tonsils. 

Symptoms of Malignant and Gangrenous Angina. 
Every inflammation of the tonsils carried to a very high 
degree may terminate in gangrene. In this case gangrene 
results from an excess of inflammation, which occasions 
the death of the parts affected; but we arc not concerned 
at present with this kind of degeneration. There is a 



PRACTICE OP MEDICINE. 89 

species of angina which exhibits the gangrenous charac- 
ter from its commencement, and which is very different 
from the others; it has a considerable relation to pustula 
maligna. The following are its symptoms: — 

Frequent horripilation, nausea, anxiety, vomiting, a 
disagreeable sensation in the throat, hoarseness: such are 
ordinarily the precursory symptoms; but as they are 
common to many affections, we cannot from them form a 
decided judgment. The diagnosis becomes less ambigu- 
ous on the appearance of the following signs. The velum 
palati and the tonsils are slightly swelled and very red; 
deglutition is but little impeded: shortly there appear on 
the diseased parts spots or crusts whitish, grayish, serpi- 
ginous, or confluent. In twenty-four hours these spots 
increase and gangrene pursues its course with rapidity; 
the slough comes away, an abundant salivation arises, and 
the patient is restored to health. At other times the gan- 
grene spreads; the whole mouth becomes black; a coryza 
is established with a secretion of fetid mucosities, which 
corrode the nose and the lips; infants are affected with 
diarrhoea; signs of gastric irritation and of typhus super- 
vene; prostration of strength, delirium, and coma. From 
the second to the third day the skin becomes covered with 
petechial spots, typhoid and of a bright red colour; this 
eruption ordinarily disappears towards the fourth day, and 
the epidermis falls off; the fever becomes more and more 
intense, symptoms of putridity supervene, and the patient 
dies ordinarily from the third to the fourth day. 

Causes of Jlngina. 
The causes of acute angina are generally all those of in- 
flammation, and particularly the sanguine temperament, 
youth, the vicissitudes of heat and cold, cold drinks when 
the body is heated, cold to the feet, hollowing, singing, 
declamation, irritating and stimulating substances, a con- 



90 THE PHYSIOLOGICAL 

tiguous inflammation extending itself to the tonsils, &c. 
The causes of chronic angina are most frequently a pre- 
ceding acute angina, or it may be chronic, that is, mild 
from its commencement; it is often kept up by a chronic 
gastritis, or the permanent action of the causes that pro- 
duced it. 

The causes of malignant or gangrenous angina are the 
same as those of pustula maligna, for we see it develope 
itself among individuals, who have eaten or handled the 
flesh and skin of animals which have been affected with 
carbuncle; it is then eminently contagious. 

Prognosis. 

Acute angina is readily cured, if attacked with vigour 
at its commencement. When there have been several 
relapses, the cure is difficult. If the phlogosis is confined 
to one tonsil, and this is swelled and hot, there is a ten- 
dency to suppuration ; but when it occupies both glands, 
and the swelling is considerable and advances rapidly, it 
may cause suffocation before the formation of pus. When 
angina is accompanied with gastro-enteritis, we may pre- 
sume that it will not be cured except with the latter 
disease. 

In gangrenous angina, lividity of the ulcers, an of- 
fensive odour of the mucous secretions, great anxiety 
and symptoms of typhus are very alarming signs: the 
decrease of fever after the eruption, gentle perspira- 
tion, the return of sleep, the desire of food, and a rosy 
colour of the ulcers are good omens. In fine, this disease 
is of little importance, if it be only local; the complication 
of gastritis, of pneumonia, or of encephalitis, leaves but 
little hope. 

Treatment. 
That of acute angina is very simple. Abundant topi- 



PRACTICE OF MEDICINE. 91 

cal bleeding by means of twenty to fifty leeches ; pursu- 
ing this plan we sometimes remove the disease in a sin- 
gle day. If there is plethora, a general bleeding must 
precede the application of leeches. But little drink 
must be allowed on account of the fatigue it occasions to 
the velum and tonsils. If the leeches do not always dis- 
perse the inflammation, they prevent its further progress. 
If the swelling advances so rapidly as to threaten suffoca- 
tion, we must repeat the application of leeches and use a 
great number; we likewise scarify the tonsils. If angina 
terminates in suppuration, we use gargarisms of the de- 
coction of mallows, of honey of roses, and finally/ of a 
slightly astringent decoction. When the patient becomes 
livid, when the breath is fetid, the pulse small, the diseased 
parts black, and there is at the same time danger of suffo- 
cation, there is no other resource than in tracheotomy. 

If angina is chronic, and kept up by a permanent cause, 
as cold, singing, hollowing, we must remove these causes; 
if by a chronic gastritis, we must combat this complica- 
tion. (See Chronic Gastritis.) If it be purely local, astrin- 
gent and tonic gargles are to be employed; and finally, if 
these means do not succeed, and the glands become hard, 
scirrhous, or ulcerated, we resort to extirpation. 

When ordinary inflammatory angina terminates in gan- 
grene, the antiphlogistic treatment is to be continued, and 
afterwards the acidulated gargles are to be resorted to. 
But when angina is really malignant and gangrenous in 
the commencement, we employ local and general stimu- 
lants, as alcohol and quinine; and for drink, the vinous 
lemonade. But when the slough comes away, we must 
suspend the use of stimulants, and replace them by emol- 
lient gargarisms and drinks. 



92 THE PHYSIOLOGICAL 

PHLEGMASIA OF THE PHARYNX AND CESOPHAGUS. 

ANGINA OF THE PHARYNX. 

The pharynx sometimes becomes inflamed under the 
influence of the same causes as the tonsils. The oesopha- 
gus is more rarely affected with inflammation, because 
there are fewer sympathies between this organ and other 
parts of the body. 

Symptoms. 
It is easy to recognise this affection by the difficulty of 
deglutition, and the pain produced by the passage of food 
along the oesophagus. There exists at the same time a 
sensation of pain and of heat with constriction of the pha- 
rynx. 

Causes. 

This phlegmasia is often occasioned and kept up by 
that of the stomach, by the ordinary causes of angina, the 
presence of a foreign body in the oesophagus, the passage 
of hot and irritating drinks and aliments, by acid and 
caustic poisons, &c. 

Treatment. 
It varies little from that of angina tonsillaris. Local 
blood-letting, emollient drinks, revulsives; if there is a 
concomitant gastritis, the complication must be treated 
appropriately. If foreign bodies are engaged in the oeso- 
phagus, they must be made to descend into the stomach, 
or be extracted by the means indicated in such cases. 



PRACTICE OF MEDICINE. 93 

PHLEGMASIA OF THE MUCOUS MEMBRANE OF THE AIR 
PASSAGES, THE LARYNX, THE TRACHEA, AND THE 
BRONCHIA. 

The mucous membrane that lines the larynx, the tra- 
chea, and the bronchia, is very often the seat of an irrita- 
tion; thence the passage to the lungs is frequent and easy. 
The history of these phlegmasia is in the highest degree 
interesting. 

When the irritation occupies the whole of the mucous 
membrane of the bronchia and of the trachea, or even of 
the larynx, it is called catarrh; its proper name would be 
bronchitis or tracheo-bronchitis. Confined to the mucous 
membrane of the larynx, it is called angina laryngsea; and 
if it at the same time involves the trachea, it is called an- 
gina laryngaeo-trachealis. In infants, angina laryngsea is 
called croup. Catarrh with convulsions is called hooping 
cough. When angina laryngaea passes into the chronic 
state, with organic alterations of the affected parts, it is 
denominated phthisis laryngasa. The name of angina 
cedematosa has been given to a phlegmonous inflammation 
of certain tissues of the larynx, other than the mucous 
membrane. We shall proceed to treat of these different 
divisions. 

BRONCHIAL OR TRACHEO-BRONCHIAL IRRITATION. 

. PULMONARY CATARRH. 

This is the most simple mode of irritation. It may 
exist in different degrees in the tracheo-bronchial mucous 
membrane: we must not therefore expect to find its exact 
model in any one shade of disease. It is sufficient to be 
well assured of the irritation, which presents itself under 
13 



94 THE PHYSIOLOGICAL 

different aspects without changing its nature, according to 
its degree, the temperament of the patient, the complica- 
tions and sympathies which it developes. As we must 
nevertheless describe one of these forms, we proceed to 
describe that which presents itself most frequently. 

Symptoms. 

Bronchial catarrh generally commences with coryza; 
on the second or third day the irritation has generally 
passed into the larynx. At other times it commences 
with a tickling in the throat, which extends itself towards 
the tracheo-bronchial mucous membrane; under other cir- 
cumstances it commences in the bronchia; there is then a 
sensation of cold at the top of the chest, and a tickling 
which provokes a deep cough. If there is coryza, besides 
the ordinary symptoms of this affection, there are those 
which announce the extension of the irritation to the tra- 
cheo-bronchial mucous membrane. A sense of fulness in 
the chest; lassitude; general uneasiness; a cough, at first 
dry, wheezing, and harassing; expectoration of mucosities, 
at first irritating; sometimes there are very painful, vio- 
lent, and convulsive fits of coughing; some patients think 
they feel a laceration in the interior of the chest. There 
often supervene symptoms announcing the communication 
of the irritation to the mucous membrane of the stomach j 
a slight fever, a frequent pulse, redness of the tongue, 
frontal pains, &c. 

These symptoms having continued some days, the irri- 
tation decreases, and the cough becomes less painful; the 
expectoration is abundant, thick and of a purulent aspect, 
the respiration is less difficult, the appetite returns, and 
expectoration continues for some days; the rheum is now 
ripe, as they say, an occurrence which takes place at a 
much earlier period in summer than in winter, because 
during the latter season, the skin being exposed to the in- 



PRACTICE OP MEDICINE. 95 

fluence of cold, vital action is exalted in the interior. It 
may degenerate into chronic catarrh. 

Causes. 
The same as those of angina and coryza; the most fre- 
quent are the vicissitude of heat and cold, and particularly 
sudden cold, when the body is heated, as on going out of 
the ball room, or an exhibition, &c. either owing to the 
influence of the air on the skin, which suddenly suppresses 
its action, and throws itself either upon the lungs or the 
pulmonary mucous membrane, or owing to the respiration 
of cold air. Cold can likewise produce this affection in 
many other ways, its effect however is always produced 
by determining an irritation of the mucous membrane; 
and it is this irritation alone that should occupy the atten- 
tion of the physician. 

Prognosis. 

Simple catarrh is not a serious disease, it only becomes 
so when inflammation invades the tissue of the lungs, an 
event of frequent occurrence, from the habit of consider- 
ing catarrh as of no moment, and therefore neglecting it. 
Sometimes the inflammation transfers itself suddenly to 
the lungs, and we have an acute pneumonia. In other 
individuals the catarrh abates during some time, it then 
returns, and thus comes and goes several times. The 
mucous irritation may last in this manner several months, 
and insensibly give rise to tubercles, to pulmonary phthi- 
sis, or in language more exact, to chronic pneumonia. 

Treatment. 

The treatment consists in removing the patient from 
the influence of the causes, and in the employment of an- 
tiphlogistic means in all their energy, to guard against 
pneumonia, which a prudent physician should always ap- 



96 THE PHYSIOLOGICAL 

prehend. If the catarrh is acute, it demands the applica-* 
tion of leeches over the trachea, and between the inferior 
insertions of the sterno-mastoid muscles; their number 
must be proportioned to the acuteness of the inflammation, 
and the strength of the patient; twenty, thirty, forty, 
fifty, or more; emollient cataplasms to the neck and the 
chest, diet, confinement to bed, warm diluent drinks, 
under this treatment the catarrh readily disappears. If 
it be less violent, we do not resort to local bleeding; but 
if the catarrh is very intense, the respiration wheezing, 
the cough very painful, and the patient strong, the appli- 
cation of leeches must be preceded by the abstraction of 
blood from the arm. What shall we say of the use of hot 
wine, of punch, of sudorific drinks, of alcoholized tea, 
and other exciting articles prescribed by some physicians 
as remedies in catarrh? These medicines, in arousing the 
action of the skin, diminish that of the mucous membrane, 
and thus sometimes operate a cure; but instead of pro- 
ducing this transfer of action, they often aggravate the 
irritation already existing, and fix it more deeply in the 
membranes which it occupies; if there is a complication 
of gastritis, which is by no means uncommon, it must ne- 
cessarily augment it. This treatment, the effect of which 
is to cure or double the disease, will never be resorted to 
by a prudent physician, unwilling to sport with the lives 
of his patients. 

We shall treat of chronic catarrh at a later period, on 
account of its connection with chronic pneumonia. 

ANGINA LARYNG.EA, OR LARYNG^O-TRACHEALIS IN 
ADULTS. 

This is a catarrh predominating in the larynx, or in the 
trachea and larynx, instead of extending over the whole 
mucous membrane of the pulmonary apparatus. This irri- 
tation is acute or chronic. 



PRACTICE OF MEDICINE. 97 

Symptoms. 

Pain, a burning heat in the larynx, sensibility increased 
by the touch, hoarseness, cough. If the patient is of an 
irritable constitution, there may be fever, difficult respi- 
ration accompanied with a kind of rattling or wheezing 
sound; the paroxysms of cough are very painful, sometimes 
accompanied with convulsions ; the patients are averse to 
deglutition, particularly in the case of liquids, on account 
of the pain which they occasion ; this fear has in some 
cases rendered them completely hydrophobic. The 
symptoms augment in intensity, albuminous concretions 
are formed in the passage, which are thrown up after 
many fits of coughing. These are not always formed 
in adults, as the mucous membrane is more dry and se- 
cretes less than among infants. 

When there is a formation of false membranes, (the re- 
sult of secretion augmented by irritation,) this angina does 
not differ at all from the ordinary croup of infants. 

Causes. 
The same as those of tracheo-bronchial catarrh. 

Prognosis. 
This irritation by itself seldom occasions death among 
adults. If it be very intense, it may extend to the lungs 
and cause death. If it is not properly treated, it may 
become chronic and degenerate into laryngeal phthisis. 
Its duration whether in the acute or chronic state is very 
various. 

Treatment. 
At the commencement of the disease, the treatment 
r;hould be vigorously antiphlogistic; the irritation must bo 
attacked without delay, by the application of leeches, to 



98 THE PHYSIOLOGICAL 

be repeated again and again, over the larynx and trachea; 
emollient cataplasms; little drink should be administered 
on account of the pain it occasions, which may augment 
the irritation; it would be preferable to administer from 
time to time small lavements. When the albuminous se- 
cretions have been formed, (if indeed they do form,) we 
need no further application of leeches, but our attention is 
to be directed to the expulsion of these mucosities. Au- 
thors have greatly lauded the sulphuret of potash and the 
carbonate of potash, as proper medicines for this purpose; 
but ipecacuanha in divided doses, or even tartar emetic, if 
the stomach is sound, are the means which succeed best. 
When the false membranes have been expelled, if there is 
still inflammation, we must continue the antiphlogistic 
treatment/and even return to the application of leeches, if 
the inflammation retains its acuteness; but in general, re- 
vulsives externally, and demulcents internally, are pre- 
ferable, after the first degrees of inflammation. This 
then, is the general outline of the treatment: to calm the 
irritation at its commencement by topical blood-letting 
and emollients, if there is the formation of a false mem- 
brane to favour its expectoration with ipecacuanha or tartar 
emetic ; afterwards to employ revulsion externally, and 
demulcents internally; to treat the complications that 
may exist by suitable means ; if there is gastritis, to apply 
leeches over the epigastric region, or to employ the emol- 
lient treatment alone, according to the intensity of the 
disease. 

ANGINA LARYNG.EA OF INFANTS. 

CROUP. 

The croup is an inflammation of the mucous membrane 
of the larynx. Sometimes it is only a catarrh, which be- 



PRACTICE OF MEDICINE. 99 

comes exasperated to such a degree as to produce angina. 
At other times the access of the disease is violent; we then 
see the infant suddenly seized with pain, heat and swell- 
ing of the larynx, fever, and suffocation. In every case it 
is an inflammation ; this inflammation is of the same nature 
as among adults; but as in infants the mucous membrane 
is more moist, and the respiratory canal more narrow, the 
albuminous secretion, which concretes into a false mem- 
brane is more abundant, and the danger of suffocation 
more imminent. 

Symptoms. 
Laryngeal angina, with the form of croup, generally 
manifests itself in infants after the time of weaning; it much 
more rarely makes its appearance among adults. There 
is pain at the upper part of the trachea, often without any 
apparent external tumour; the peculiar sound of the croup 
characterizes the cough and the cries; this sound, which 
has been compared to the crowing of a cock, seems as 
though it came from a metallic tube; the respiration is 
difficult, and attended with a sibilant noise; the cough is 
convulsive and dry in the commencement; suffocation is 
threatened. Sometimes there is an expectoration of mem- 
branous concretions; the face is livid or red, especially 
during the fits of coughing; there is often fever, the 
pulse is frequent and weak, and the patient may be carried 
off suddenly by suffocation. 

Causes. 
Cold, the vicissitudes of heat and cold, humidity of the 
atmosphere, the inspiration of irritating vapours or gases, 
and a particular predisposition. 

Prognosis. 
The danger is in proportion to the intensity of the in- 



100 THE PHYSIOLOGICAL 

nammation, and particularly to the quantity of albuminous 
secretion, on account of its tendency to produce suffoca- 
tion. A sibilant and stertorous breathing, great anxiety, 
and violent fever, are ominous: the expectoration of the 
false membrane, free respiration, and a voice nearly na- 
tural, are very favourable signs. 

y Treatment. 

By administering the tartar emetic at the commence- 
ment, we can operate a salutary revulsion; but are we 
sure of producing this effect? May we not exchange an 
irritation of the larynx for a serious gastritis? besides, may 
not a gastric irritation be added to the laryngeal one, and 
thus increase the danger? Unhappily, experience proves 
how well founded these apprehensions are, and some in- 
stances of success occurring now and then should not au- 
thorize a treatment so contrary to all the laws of phy- 
siology. 

The name of croup is of no consequence: our object is 
to arrest the progress of the irritation, for we have here 
to do with an irritation of the mucous membrane of the 
larynx and trachea. If then we are called at the com- 
mencement of the disease, we must employ topical blood- 
letting, and repeat it more or less frequently, by means 
of four, five, or six leeches applied over the seat of the 
disease. We must use a much greater number in the 
case of adults. Emollient cataplasms, mild drinks, and 
pediluvia. When the membrane is formed, we favour its 
expulsion by the use of ipecacuanha in divided doses; 
when the intensity of the inflammation has abated, we 
may cautiously employ revulsives on the alimentary canal, 
for example, a few grains of calomel; but this is on condi- 
tion there exists no intestinal irritation. It is often the 
case that gastritis accompanies the croup; in this case we 
apply leeches to the epigastric region. We should cease 



PRACTICE OF MEDICINE. 101 

bleeding after the production of the false membrane; when 
it is expelled we confine ourselves to demulcent remedies. 



CONVULSIVE IRRITATION OF THE AIR PASSAGES. 

HOOPING COUGH. 

Hooping cough is a catarrh or irritation of the tracheo- 
bronchial mucous membrane, with a convulsive cough. 
It is principally seen among children and nervous wo- 
men. 

Symptoms. 

The symptoms during the first days are those of pul- 
monary catarrh, or of laryngeal angina, afterwards there 
occurs a convulsive cough, which is often repeated fifty, 
sixty, or eighty times without intermission. The fit ge- 
nerally terminates by the vomiting of mucosities, and the 
patient finds himself in a state of extreme exhaustion. 
Redness of the eyes, and of the face; a swelling of the 
veins, and a throbbing of the arteries of the face and of 
the neck; sometimes the excrements and the urine escape 
involuntarily; difficult inspiration; a peculiar sound of the 
voice during coughing, (it has been compared to the cries 
of the wolf.) The attacks are irregular. 

The duration of the convulsive catarrh varies with the 
circumstances, the age, and the temperament of the per- 
son affected: sometimes it continues during entire seasons; 
it often terminates by vomiting. It may degenerate into 
pneumonia or laryngeal phthisis; the blood may accumu- 
late in the head, under the influence of the paroxysms of 
cough, and determine convulsions, and even epilepsy; the 
heart and the great vessels may undergo considerable di- 
latation, occasioned by the stagnation of blood in the 
lungs, &c. 

11 



102 THE PHYSIOLOGICAL 

Causes. 
The irritation of the pulmonary passages is associated;, 
(probably,) with a nervous irritation. The occasional 
causes are consequently those of ordinary catarrh. Infants 
are more liable to it than adults. It sometimes prevails 
epidemically, under the influence of a peculiar atmospheric 
constitution. The seat of this disease has been impro- 
perly referred to the stomach, on account of the convulsive 
cough often terminating by vomiting. But autopsy solves 
the difficulty; in fact, we only find traces of inflammation 
and organic alterations similar to those we observe as the 
result of ordinary catarrh, of pneumonia, and of laryngitis: 
sometimes we find signs of gastritis, an engorgement of 
the brain, or an aneurism of the heart. 

Prognosis. 
This disease is almost constantly fatal among infants 
under eighteen months or two years of age. When it 
continues a long time, there is danger of its degenerating 
into chronic pneumonia or into laryngeal phthisis, and if it 
be violent, it may be productive of the accidents we have 
already notieed. 

Treatment. 
At the commencement, the treatment is the same as in 
ordinary catarrh: leeches to the larynx and trachea; the 
number of leeches, and the repetition of their application, 
must be determined by the age and strength of the pa- 
tient, and particularly by a consideration of the intensity 
of the inflammation; the bites are to be covered with 
emollient cataplasms; mucilaginous drinks, pediluvia ren- 
dered stimulating with mustard, milk and vegetable diet. 
If the patient is threatened with pneumonia, with pleurisy, 
with cerebral congestion, with dilatation of the heart, ge- 



PRACTICE OF MEDICINE. 103 

neral bleeding must be resorted to, followed with topical 
depletion over the parts menaced with inflammation. 
When the inflammation has been subdued by the blood- 
letting, and the emollients have been continued for a suffi- 
cient length of time, we must combat the convulsive dis- 
position with antispasmodics. Experience seems to have 
demonstrated the superiority of belladonna over the others. 
We administer it first in the dose of an eighth of a grain, 
then of a sixth, and finally of a quarter of a grain, repeat- 
ed five or six times during the day; this remedy, how- 
ever, is only to be resorted to after the employment of 
the antiphlogistic treatment, and when the state of the ali- 
mentary canal is sound. If the paroxysms of cough are 
periodical, we may administer the sulphate of quinine 
after the antiphlogistic treatment, and under the same re- 
strictions as the belladonna or other antispasmodics. 

CHRONIC LARYNGITIS, OR TRACHEITIS. 

The inflammation of the mucous membrane lining the 
passage to the lungs often becomes chronic; hence result, 
sometimes, ulcerations, or other local organic alterations: 
we then denominate it laryngeal or tracheal phthisis. 

Symptoms. 

Pain in the larynx, the trachea, the origin of the bron- 
chia, or behind the sternum, according to the seat of the 
disease, alteration of the voice, the hoarseness of which 
is greater or less, according to the seat of the disease; it 
is less if the irritation predominates in the bronchia; it is 
much greater if the larynx is chiefly affected. Besides this, 
pain is developed by pressure, if the larynx is most affected; 
but if the inflammation be most violent at the bifurcation of 
the bronchia, the patient may experience attacks of asthma 
and of suffocation; the voice is wheezing; respiration is labo- 
rious; it is attended by a species of rattling, (rale.) There is 



104 THE PHYSIOLOGICAL 

expectoration of false membranes, of small flakes of thick 
whitish mucus, sometimes resembling bits of cheese, or of 
small calculi enveloped in a caseiform matter, &c. the 
uneasiness of the patient augments when the atmosphere is 
damp.* 

In the commencement there is no fever; but if the dis- 
ease continues, fever supervenes with exacerbation in the 
evening, there is redness of the cheeks, heat of the skin, 
night sweats; in the morning there is a remission of all 
these symptoms of chronic pneumonia, (phthisis pulmo- 
nalis.) The symptoms enumerated announce the invasion 
of the pulmonary parenchyma by the inflammation. 

Causes. 
An acute inflammation, such as tracheo-bronchial ca- 
tarrh or angina of the larynx; sometimes the chronic form 
of the disease developes itself at the commencement, and 
without being preceded by the acute stage; this takes place 
under the influence of mechanical causes, singing, decla- 
mation, or other efforts of the voice; blows upon the la- 
rynx, &c. 

Prognosis. 

As long as there is no organic irritation of the larynx 
or trachea, as long as the inflammation has not invaded 
the parenchyma of the lungs, there is hope. There is 
however but little prospect of recovery in the first cases, 
especially if the disease continues notwithstanding the use 
of the curative means we are about to point out; in the 
second case, which is recognised by the existence of hectic 
fever, and the other symptoms of chronic pneumonia, 
there is no possibility of a favourable issue. 

Dissection exhibits redness of the mucous membrane of 
the larynx and trachea, sometimes caries of the cartilages 
of the larynx, and ulcerations covered with false mem- 



PRACTICE OP MEDICINE. 105 

branes; sometimes tubercles result from the swelling of 
the bronchial ganglions, and many other kinds of disorga- 
nization are observed; we often meet with structural de- 
rangement in the tissue of the lungs of the same nature 
with those occurring in chronic pneumonia; very fre- 
quently there are profound traces of gastro-enteritis. 

Treatment. 
The language of ancient physicians was, if there are 
tubercles, nothing can be done, but if not, the patient may 
be cured. The language of physiological physicians of 
the present day is, as tubercles are nothing but the pro- 
duct of inflammation, let us prevent their formation by 
attacking this irritation at an early period, and with per- 
severance. In pursuance of this plan, if there is acute 
catarrh, we treat it according to the method already laid 
down; if it exists in the chronic form, whether primitive- 
ly or consecutively to the acute, we must not give time 
for the formation of ulcers or tubercles. We shall there- 
fore insist upon the employment of topical depletion ; the 
application of leeches over the larynx and trachea, in small 
numbers; this is to be often repeated, and to be persevered 
in during several weeks or even months. Fomentations 
and emollient cataplasms are to be used, afterwards moxa 
is to be applied in three or four places, on each side of the 
larynx. After topical bleeding, this kind of revulsion 
has produced astonishing effects in cases that appeared 
desperate. It is proper to insist upon this means when 
there is dyspnoea and wheezing respiration. When there 
is constriction or convulsion of the larynx, and the anti- 
phlogistic and revulsive treatment has been continued for 
a sufficient length of time, we may administer some of the 
antispasmodics, such as opium, in an appropriate vehicle, 
or emulsions slightly camphorated, but we must not push 
too far their employment. 



106 THE PHYSIOLOGICAL 

If the disease resists the local bleedings, and the moxa, 
the danger is extreme. The food should be of the mild- 
dest kind ; milk, if the patient digests it with ease, gruel 
of substances containing fecula, prepared with milk or fresh 
butter, cooked fruits and fresh vegetables, are the only 
suitable aliment. If irritation of the larynx has succeeded 
an arthritic affection, or the suppression of an habitual 
evacuation, such as the haemorrhoids, we employ revulsion 
upon the parts primitively affected, with the view of re- 
calling the irritation to the part which it occupied at first 

CEDEMATOUS ANGINA. 

This is an inflammation of the body of the larynx, 
which should not be confounded with irritation of the 
mucous membrane. 

Symjjtoms. 
There are positive symptoms which indicate the seat 
of the inflammation; there are negative ones which de- 
monstrate that this seat is not the mucous membrane. 
The former are, difficulty of respiration; a feeling of 
strangulation; swelling; sensibility of the larynx develop- 
ed by the touch; the latter are, the absence of cough, of 
the rale, and the voice remaining unchanged. This phleg- 
masia seems to commence in the tissues situated between 
the cartilages. The swelling of the larynx comes on by 
degrees, the surrounding cellular tissue becomes (Edematous, 
and impedes respiration; an abscess is established, which 
obstructs the passage to the lungs, and the patient dies of 
suffocation; this event may occur, owing to the tumefac- 
tion alone, and before the establishment of suppuration. 
Sometimes this inflammation pursues a rapid course; at 
other times its progress is tedious and chronic, and may 
continue during many years. 



PRACTICE OF MEDICINE. 107 

Causes. 
The causes are, in general, those of inflammation; in 
particular, they are external violence; the cravat worn too 
tight; cold; singing; loud cries. This malady seems to 
choose for the objects of its attacks lymphatic individuals, 
and those of a scrofulous constitution. 

Prognosis. 
It is unfavourable if the disease be not attacked with 
energy in its commencement, because the inflammation 
may promptly bring on disorganization. The chronic 
state is the more dangerous, because it often determines 
caries of the cartilages. The formation of abscesses in- 
ternally may rapidly produce suffocation; if they open ex- 
ternally, the patient may be cured. 

Treatment. 
The treatment must evidently be of the most prompt 
and energetic character, on account of the imminence of 
the danger. Thus we repeat, time after time, the appli- 
cation of leeches to the larynx and its vicinity, to the 
number of twenty, thirty, forty, or fifty ; emollient cata- 
plasms, diet, and pediluvia rendered irritating with mus- 
tard. If the inflammation is very acute, venesection 
should be practised before the application of leeches. If 
the disease is far advanced, and there exists disorganiza- 
tion, leeches and diet would only reduce the patient to no 
purpose ; \vc then have recourse to revulsives, the moxa, 
dry cupping, blisters, and palliative remedies. If an ab- 
scess threatening suffocation has formed in the interior, 
we endeavour to give an outlet to the pus, by resorting 
to a suitable operation in the interior of the larynx, or on 
the exterior, according to circumstances. Finally, we 
practice tracheotomy, if there is no other way of prevent- 



108 THE PHYSIOLOGICAL 

ing suffocation ; we however have recourse to this means 
only when there exists some hope of cure. 

PHLEGMASIA OF THE PECTORAL VISCERA. 

Hitherto we have only discussed phlegmasia limited to 
the mucous membranes of the air tubes; Ave now proceed 
to the consideration of those of the parenchyma of the 
lungs, of their envelopes, (the pleura?,) of the pericardium, 
and of the heart. Inflammation of the tissue of the lungs 
is called pneumonia; when it occupies, at the same time, 
the tissue of the lungs and the pleura, it takes the name of 
pleuro-pneumonia; confined to the pleurae, (an extremely 
rare case,) it is denominated pleurisy or peripneumonia. 
The inflammation of the pericardium is called pericarditis; 
that of the heart has different names, such as carditis, aneu- 
rism, &c. When pneumonia passes into the chronic state 
it is called phthisis pulmonalis. Chronic pneumonia is a 
more proper appellation, because it indicates better the 
nature of the affection. No matter, however, what the 
names may be by which these diseases are designated, the 
physiological physician knows that in the ultimate ana- 
lysis, he has to deal with an irritation which is always 
identical, and of which it concerns him to know the seat 
and the intensity, as well as the structural derangement 
which it has produced or may produce. The senseless no- 
menclature, based upon fugitive symptoms, and not upon 
the state of the organs, serves only to obscure the science, 
and to destroy simplicity of treatment. 

ACUTE PNEUMONIA AND PLEURO-PNEUMONIA. 

Pneumonia is sometimes preceded by bronchial catarrh. 
The inflammation passes then from the bronchia into the 
areolar tissue of the lungs, or it arrives there by the pleura. 



PRACTICE OF MEDICINE. 109 

At other times it developes itself suddenly in the lung 
itself. 

Symptoms of Acute Pneumonia. 

Whatever may be the route which irritation has pursu- 
ed, the following are the symptoms indicating the exist- 
ence of its seat in the pulmonary areolar tissue : shiver- 
ing; great oppression; the shivering does not occur if the 
catarrh has preceded the pneumonia; dyspnoea, a sense of 
suffocation, a deep cough, pain of the side, generally fixed, 
pungent, sometimes obtuse, with a sense of weight, felt 
most frequently under the sixth or seventh rib, some- 
times under the scapulas, the clavicles, or the sternum ; 
this pain augments considerably, if the patient attempts 
to make a full inspiration; decubitus painful upon the 
side opposite to the seat of the disease, more easy upon 
the back if both sides are affected, cough more or less vio- 
lent from the beginning: at first scarcely any expecto- 
ration, afterwards an expectoration more or less abundant, 
viscid, and mixed with bloody striae, a species of rale, or 
rattling, rendered perceptible by the cylinder, a dull sound 
produced by percussion over the seat of the inflammation; 
this seat is at the upper part of the lungs, when a catarrh 
has preceded the pneumonia; when it comes on suddenly 
it generally occupies the middle or inferior part of the 
pulmonary structure. The pulse is full, large, and hard ; 
but the fullness ceases if the disease advances; there is a 
deep red colour of the face, and particularly of the cheek 
of the affected side ; there is often complication of gas- 
tritis, (under the form called bilious, or inflammatory, &c.) 

When pneumonia proceeds rapidly, the sound elicited 
by percussion becomes more and more dull, the respira- 
tion is more accelerated, the pulse more rapid, the colour 
of the cheeks becomes livid, sometimes the centre of the 
cheek is surrounded by a yellowish circle, a profuse per- 
15 



110 THE PHYSIOLOGICAL 

spiration bathes the neck, the face, and the chest; water- 
ing of the eyes, anxiety and distress of countenance, an 
expectoration by no means abundant, and sometimes 
bloody, the gurgling sound of the chest increases, the 
pulse becomes small, wiry, rapid, in a short time the 
patient cannot sit up in bed, sometimes the want of res- 
piration is urgent, and yet the patient is unable either to 
breathe, to speak, or to drink, on account of the pain it 
occasions; he only gives utterance to a word at a time; 
he experiences a sense of suffocation; the extremities be- 
come cold, a viscid sweat breaks out over the whole body, 
and death occurs sometimes at the end of two, three, or 
four days; at other times the disease is of longer continu- 
ance ; in the greater number of cases it is cured; when 
this takes place, all the symptoms diminish gradually in 
intensity, the respiration becomes more free, a gentle 
moisture overspreads the skin, the expectoration becomes 
abundant and easy, the pulse becomes less frequent, the 
pain diminishes, &c. hsemoptysis is sometimes observed to 
supervene and dissipate the pneumonia; this haemorrhage 
may be considered in many cases as the natural remedy 
of pneumonia. 

Symptoms of Jicute Pleuro-pneumonia. 
Inflammation of the lung, or pneumonia, is often at- 
tended with that of the pleura, or with pleurisy; the lat- 
ter may also exist alone, particularly in the commence- 
ment. Pleuro-pneumonia may exist on one side alone, or 
there may be pleurisy of one side and pneumonia of the 
other. In this case there is acute pain of the pleuritic 
side, which is augmented by pressure or percussion, the 
patient scarcely dares to respire or to cough, because the 
movement of the ribs necessarily occasions that of the 
pleura, which render the pain more intolerable; some- 
times the patient is incapable of drinking, of speaking, or 



PRACTICE OF MEDICINE. Ill 

of changing his position. The sound is ordinarily clear 
over the pleuritic point, and dull over the part where the 
lungs is affected, but as the inflammation ordinarily tra- 
vels from the pleura to the corresponding part of the lung, 
the sound there in a short time changes from distinct to 
dull. As long as inflammation is confined to>he pleura, 
the pulse is frequent, quick, less full and not so large as 
in pneumonia; the corresponding cheek is less red, the 
visage less swelled, and the expression of the countenance 
less unfavourable. In simple pleurisy the cylinder indi- 
cates no change in the respiration, but if two or three days 
later, we perceive a crepitation, a species of ' rale', or a 
gurgling noise, the inflammation has reached the tissue of 
the lungs, for this noise is occasioned by the passage of 
air through mucosities, the secretion of which is augment- 
ed by the inflammation. If the disease continues, there 
may supervene organic alterations, such as hepatization, 
tubercles, gangrene, empyema, adhesion of the pleura, 
hydrothorax, &c. The parts affected are no longer fit for 
respiration, and the cylinder transmits no sound. Thus, 
when a patient suffers from a state of dyspnoea, if there is 
a dull sound in a part formerly affected, and acute pain on 
pressure, in the same or another place, we have a pleuro- 
pneumonia. In simple pleurisy there is acute pain aug- 
mented by the touch, and inflammation of the two pleu- 
ritic surfaces which correspond to each other; the ribs 
then remain motionless on account of the pain. 

Pulmonary irritation may then attack the parenchyma 
of the lung alone, constituting pneumonia; or the pleura 
alone, constituting pleurisy ; or it may assail both at the 
same time, giving rise to pleuro-pneumonia. Sometimes 
catarrh, pneumonia, and pleurisy exist simultaneously. 

Gastro-entcritis is often found accompanying irritations 
of the lungs. In this case, to the preceding symptoms are 
joined those which indicate this complication, redness of 



112 THE PHYSIOLOGICAL 

the tongue, a bitter taste, a fuliginous state of the mouth, 
pungent heat of the skin, thirst, &c. according to the in- 
tensity of the gastro-enteritis. The bilious, gastric, malig- 
nant, putrid, adynamic, &c. pleurisy and pneumonia of au- 
thors, are only ordinary pleurisy and pneumonia compli- 
cated with gastro-enteritis, the form of which varies with 
the intensity of the inflammation and the constitution of 
the subject; on this subject dissection leaves no doubt. (See 
Gastritis and Gastro-enteritis.) Acute pneumonia or pleu- 
ro-pneumonia may terminate by resolution, suppuration, 
gangrene, hydrothorax, or chronic pneumonia. 

Causes. 
Pneumonia may be referred to irritation of the bron- 
chial mucous membrane, extending thence to the areolar 
tissue, as its first cause. The most ordinary cause is cold, 
which acts externally, diminishes the action of the skin, 
and checks the pulmonary transpiration; or it may act in- 
ternally by means of cold drinks, or the inspiration of 
cold air when the lungs are much heated, as on coming 
out of the ball-room or a numerous assembly, or after vio- 
lent exercise; every thing that throws the blood upon the 
lungs or causes their engorgement, such as strong emo- 
tions, which determine chilliness of the surface and the 
concentration of heat in the interior; the chill which 
ushers in the fever in intermittents, the vicissitudes of 
heat and cold, irritating gases, singing, and declamation. 
These different causes may produce catarrh, pneumonia, 
or pleurisy. To these causes may be added external vio- 
lence, as blows and falls upon the chest. The organic 
alterations which we find constantly at the termination of 
these maladies, are the consequence, never the cause of 
the irritation. 



PRACTICE OP MEDICINE. 113 

Prognosis. 

When very acute, this disease may prove fatal in three 
or four days. Avery difficult respiration, a frequent and 
very painful cough, great anxiety, delirium, the respiration 
becoming suddenly accelerated and short, a gurgling 
sound, and coldness of the feet, are signs which indicate 
the violence of the inflammation and the imminence of 
the danger. An easy expectoration of yellowish thick 
matter, sometimes tinged with blood, without violent 
cough; an epistaxis, or an haemorrhagy by the hsemorrhoi- 
dal vessels, or the eruption of an external irritation, an- 
nounces that the inflammation is not very intense, or that 
a translation of irritation, (metastasis,) has occurred, which 
is generally favourable. 

We may apprehend suppuration when the symptoms 
persist with the same intensity during twelve, thirteen, 
or fourteen days. We may suppose that it already exists, 
if the pain diminishing, the dyspnoea continues; if there 
are shivering, hectic fever, and decubitus more easy on 
the affected side. We may judge that there is effusion, 
if the respiration becomes suddenly embarrassed and hur- 
ried, and the patient is obliged to have his body elevated 
for the purpose of executing it. 

Treatment. 

Rigorously antiphlogistic. It is of importance to lose 
no time, on account of the rapid progress of this disease. 
General blood-letting, abundant and repeated, is peculiarly 
suited to pneumonia, and topical to pleurisy; but Ave may 
follow up the general with topical bleeding, when there 
is heat at the top of the sternum, (this is bronchial catarrh,) 
leeches should then be applied to the lower part of the 
neck, over the course of the trachea. 

In violent pleurisy, a general bleeding may precede the 



114 THE PHYSIOLOGICAL 

local; this last may be performed by means of leeches to 
the number of thirty, forty, fifty, and upwards, or by 
means of cups; this is one of the cases where cupping or 
leeching may be used indifferently. We repeat often, 
and with confidence, the application of leeches, if the 
symptoms persist. 

It is difficult to determine at what period of the disease 
we should employ blood-letting; here the violence of the 
inflammation must serve as our guide; we may generally 
employ this remedy when the pain is intense and of little 
extent, no matter what may have been the duration of the 
disease, even though it may have existed for thirty or forty 
days. It is absurd to say that in this disease we should 
not bleed after the fourth day. Bleeding should be dis- 
continued when prostration supervenes, should this occur 
on the third day. It is also improper when the dull 
sound exists over a great extent. Bleeding under such 
circumstances hastens the fatal termination. 

If there is a complication of gastritis, or of gastroen- 
teritis, authors advise purgatives and emetics, especially 
when the bilious shade exists. Many cases of cure are 
cited, but as a revulsion is operated by these means, there 
is never a certainty that they will not occasion a greater 
irritation than already exists; this never fails of being the 
case if the gastro-intestinal irritation possesses ever so 
slight a degree of intensity: thus, in the cases called bili- 
ous pleurisy, bilious catarrh with inflammatory angio- 
tenic, &c. fever, it is a more rational and certain mode of 
treatment, to apply at the commencement leeches to the 
epigastric region. If evacuants could in any case be called 
for, it would rather be where there was no complication 
of gastritis; but the experiment is always uncertain. 

After bleeding, as well general as local, we employ re- 
vulsives, but it is essential that the inflammation be first 
subdued or very much abated; for blisters applied during 



PRACTICE OP MEDICINE- 115 

the acute stage almost always augment the inflammation. 
The blisters should be applied to the chest itself, and not 
to the thighs or arms, where revulsion is impossible. 

The diet should be severe or absolute, if the inflamma- 
tion is violent; and if there is a complication of gastritis, 
mucilaginous drinks should be administered, no acids 
should be allowed, as they augment the cough and thus 
increase the irritation. 

If after all these means, the cough continues, we may 
give the patient some emulsion, or an infusion of the 
flowers of orange, containing a small quantity of opium, 
on condition however, that there does not exist the slight- 
est complication of gastritis, which is known by the clean- 
ness of the tongue and the absence of the other symptoms 
of this complaint. During the convalescence, we pursue 
the same course as in gastritis. (See Regimen of Conva- 
lescents.) 

PERICARDITIS. 

This is an inflammation of the serous membrane which 
surrounds the heart; it has a considerable relation to 
pleurisy, but it less frequently occurs. 

Symptoms. 

Pain at the region of the heart augmented by pressure, 
the movements of this organ are irregular, quick, tumul- 
tuous, pulse is ordinarily wiry, small, quick, sometimes in- 
termittent; the pulse may be developed in the beginning, 
and afterwards become small in proportion to the progress 
made by the irritation; immobility of the ribs which 
cover the heart, respiration embarrassed, interrupted; a 
sense of suffocation arising from a stagnation of blood in 
the lungs, a tendency to syncope, because the heart can- 
not distribute the blood in a uniform manner to the differ- 
ent viscera; a fear of falling into a state of debility and 



116 THE PHYSIOLOGICAL 

even of death. Pericarditis may accompany pleurisy; 
this complication is easily recognised. (See Symptoms 
of Pleuro-pneumonia. ) 

It may be complicated with gastritis, or with gastro- 
enteritis; the redness of the tongue, and the other symp- 
toms of gastritis readily point out this complication. 

Causes. 
Cold, mechanical lesions, blows, falls, pleuritic inflam- 
mation, extending itself to the pericardium. It is often 
produced by arthritic or muscular irritation repeated on 
the pericardium ; it is this that is then improperly said to 
be gout, or rheumatism, attacking the heart. 

Prognosis. 
Very violent pericarditis may be mortal in as short or 
even a shorter space of time than pleurisy or pneumonia; 
there is often formed in a very short time a purulent col- 
lection which embarrasses more and more the motions of 
the heart, and leaves but little hope. Cold sweats, con- 
vulsive movements, and frequent syncope, are the pre- 
cursory signs of death. If the pulse preserves or resumes 
some degree of largeness and slowness, it is a good sign. 

Treatment. 
The same as that of acute pleurisy; but to be successful, 
we must treat the disease with boldness, and from the 
commencement; for if we do not see the patient for two 
or three days after the commencement, there is scarcely 
any thing to be hoped for from any kind of treatment. 
The appropriate remedies are local bleeding, frequently 
repeated; absolute rest; silence; severe diet; and emollient 
drinks. The complications of pneumonia, of pleurisy, or 
of gastritis, are a further motive for insisting upon the an-« 
tiphlogistic treatment. 



PRACTICE OP MEDICINE. 117 

When the inflammation is subdued, revulsives are pro- 
per. 

CHRONIC FORMS OP IRRITATION OF THE PECTORAL VIS- 
CERA. 

All the irritations of the pectoral viscera, which have 
been treated of, are capable of assuming the chronic form. 
These chronic irritations most frequently succeed the 
acute form; but they may be mild from the beginning, 
without having been preceded by the acute form. 

CHRONIC PULMONARY CATARRH. 

It often happens that prolonged irritation of the bron- 
chial mucous membrane terminates in chronic pneumonia. 
We judge that it has interested the pulmonary structure 
when fever supervenes, or the slight febrile motion al- 
ready existing, continues; when there are nocturnal ex- 
acerbations; acceleration of the pulse; redness of the 
cheeks; a dull sound below the clavicles. In this case the 
disease is serious, constituting chronic pneumonia, or pul- 
monary phthisis, of which we shall presently treat. It 
is, therefore, necessary to characterize well the disease of 
pulmonary catarrh, to prevent its leading to such a catas- 
trophe. 

Symptoms of Chronic Pulmonary Catarrh. 
While the phlegmasia is confined to the mucous mem- 
brane of the bronchia, there is habitual cough; expectora- 
tion of mucosities, clear or opaque, whitish, sometimes 
in small quantity, at other times in great abundance. 
These symptoms are augmented in intensity by cold feet; 
by the passage from a warm to a cold temperature; and 
after a repast, or violent exercise. On waking, the pa- 
16 



118 THE PHYSIOLOGICAL 

tient feels a desire to expectorate, or he is even wakened 
by the necessity of expectoration, produced by the accu- 
mulation of mucosity in the bronchia, during sleep; but 
it is essential to remark that there is no fever; no dull 
sound; the cylinder transmits a rattling or rather a pro- 
found agitation of mucosities: the appearance of these 
symptoms is the signal of the invasion of the lungs. 
Many individuals carry for a long time this bronchial irri- 
tation without being incommoded by it; it may persist 
during many months, and even many years; it may very 
readily return to the acute stage, under the influence of 
the slightest causes, and thus carry off the patient. 

Causes. 
Most frequently chronic catarrh is consecutive to the 
acute; it is produced and kept up by the same causes. 
Catarrh may co-exist with pneumonia, pleurisy, aneurism 
of the heart, or gastritis. 

Prognosis. 
If pulmonary catarrh be not arrested, three things may 
occur: it may pass to the acute state; it may determine 
chronic pneumonia with all its forms; or it may give rise 
to lymphatic engorgements, (tubercles,) around the bron- 
chia, in the same manner as gastro-enteritis produces in- 
flammation of the glands of the mesentery: this happens 
chiefly among lymphatic individuals. There is hope as 
long as irritation is confined to the mucous membrane; 
but when the lung is deeply affected, particularly when 
catarrh has existed for a long time, there remain no 
grounds of hope. We may regard chronic catarrh as the 
most frequent cause of chronic pneumonia, (phthisis pul- 
monalis,) because, under the pretext that this is but a 
rheum, time is given for the irritation to extend itself to 
the tissue of the lungs. 



PRACTICE OP MEDICINE. 119 



Treatment. 



In strong, sanguine, plethoric subjects, the treatment 
should be antiphlogistic; from time to time local bleeding 
by means of ten, twelve, or fifteen leeches to the trachea; 
the removal of the causes which may keep up the disease. 
In subjects who are weak, lymphatic, badly nourished, 
and badly clothed, the pulmonary catarrh may continue 
during the whole bad season, and not cease until the re- 
turn of warm weather; the proper plan then is to feed 
these patients well, and to clothe them warmly; to allow 
them a little wine; to administer some of the tonics, such 
as Iceland moss; light decoctions of bark; some sudorific 
drinks; squills in a mucilaginous draught, &c. A blister 
upon the chest sometimes has marvellous effects; but the 
employment of stimulants requires much prudence. If 
we pursue the plan of routine practitioners, and know not 
how to stop at the proper point, we may produce gastri- 
tis, or chronic pneumonia. 

If complications of gastritis, of pneumonia, of pleurisy, 
of hypertrophy of the heart supervene, we treat these com- 
plications by the customary means, (see these diseases.) 
If the catarrh assumes the acute form, we employ local 
bleeding, and a treatment decidedly antiphlogistic. 

CHRONIC PLEURISY. 

Ancient authors have often confounded this disease 
with dropsy of the chest, and aneurism of the heart, or 
rather they have given these names to what was in reality 
a chronic pleurisy. Chronic pleurisy is an irritation of 
the pleura. Under the influence of this irritation the se- 
cretions may become changed, and give rise to a serous 
or purulent collection; this collection may compress the 
lungs, and lead to the suspicion of their being in a state of 
atrophy; adhesions of the lungs may be formed and an 



120 THE PHYSIOLOGICAL 

infinite number of other alterations, which are nothing but 
the result or the symptoms of pleuritic irritation. It is 
then this irritation which should fix the attention of the 
physician; the symptoms should only serve to indicate the 
disease, instead of being considered the principal disease. 

Symptoms. 
When the acute form has preceded, it is very easy to 
recognise the chronic. The fever ceases, the patient re- 
gains his strength, the appetite returns; but he is out of 
breath after walking, and after a meal, he coughs a little, 
he has dyspnoea, the sound becomes dull in the place 
where the pain was felt, and this sound even extends over 
a great part of the lung, proving, either that pneumonia 
is joined to pleurisy, or that there is an effusion. When 
pleurisy has not commenced with the acute stage, but has 
made its approach in a slow, occult, and insidious man- 
ner, it is usually neglected, because its symptoms are at 
first little apparent and do not excite attention, until the 
disease has gone so far as to give rise to the phenomena 
above enumerated. As the disease advances, it tends in 
a manner more or less decided to hydrothorax, or pneu- 
monia, or to these two affections simultaneously. When 
there is dropsy and the collection is considerable, the lung 
of the diseased side is compressed, and reduced to a small 
volume, no longer giving passage to the blood ; there is a 
dull sound and dyspnoea, but the patient retains his appetite, 
and there is little fever. If, on the contrary, there is 
pneumonia, beside the dull sound there is fever and red- 
ness of the cheeks. If one lung alone is compressed by 
the serous or purulent collection, the other acquires an ex- 
altation of energy, which disposes it to inflammation, on 
account of the great quantity of blood which it is obliged 
to receive. The patient experiences uneasiness and even 
pain of this side, while the side really affected is often in- 



PRACTICE OP MEDICINE. 121 

sensible. At other times pneumonia supervenes in the side 
which had remained sound, and this case is almost always 
fatal. In some patients the acute phlegmasia grafts itself 
on the chronic, and then woe to the patient, if the dull 
sound existed before this new accident. In others there 
is dropsy of the chest well characterized ; this dropsy 
may become general; we have then bloated face and eye- 
lids, infiltration of the feet, of the legs, and often of the 
whole cellular tissue. Sometimes the lower part of the 
affected side suffers pain, produced by the compression of 
the brachial plexus. Gastritis very often supervenes, 
especially when the pleurisy has existed for a long time. 
There may, likewise, often exist a complication of hyper- 
trophy of the heart. 

Causes. 
Chronic pleurisy often commences with the acute; the 
latter ought in this case to be considered as the cause of 
the former; but the pleurisy may likewise commence in 
an occult manner, and it should then be considered as 
chronic from the beginning; for the degree of irritation, 
and not the duration, constitutes the real character. Wan- 
dering, rheumatic, and arthritic pains, or rather the irrita- 
tion which produces them, fix themselves sometimes upon 
the lungs, and give rise at one time to an acute, at another 
to a chronic pleurisy. Falls and blows upon the chest often 
leave a slight pain, which finally determines a phlegmasia 
of the pleura. Attacks of intermittent fever leave some- 
times a point of irritation in the pleura, which often dis- 
appears, but which sometimes remains and brings on 
chronic pleurisy. 

Prognosis. 
When there is induration of the lung, or hepatization, 
the evil is greater than when there is simple compression, 



122 THE PHYSIOLOGICAL 

produced by effusion; for in the last case absorption may oc- 
cur and the lung insensibly return to its primitive condition, 
retaining, however, a certain degree of atrophy. Most fre- 
quently, however, the patient falls a victim either to the 
pneumonia which supervenes on the pleurisy, or to the 
gastritis, or to compression of the lungs, the heart, or 
the great vessels. When the dull sound has but little ex- 
tent, the patient may yet exist a great number of years; 
sometimes the inflammation terminates in the adhesion of 
the pulmonary to the costal pleura, and the patient may 
be regarded as cured, with the exception of a slight em- 
barrassment of the respiration: this termination, however, 
is extremely rare. 

Treatment. 
It is easier to prevent than to cure chronic pleurisy; 
it is therefore of the greatest importance to arrest in good 
time the acute stage, to prevent such a termination. The 
therapeutic means may, however, be crowned with suc- 
cess when the disease is not of very old standing, when 
the dull sound is of little extent, when there is no fever, 
no circumscribed redness of the cheeks; for in this case 
the dull sound is owing to a collection of matter, the ab- 
sorption of which is not impossible. Absolute rest, a light 
milk diet, and abstinence from every kind of exciting 
drink, must be rigorously enjoined; but it is upon revul- 
sives that we must depend as the most efficacious means, 
when there remains any hope of cure. We shall then de- 
termine an absorption or a revulsion, particularly in young 
subjects, by the employment of blisters, of the moxa, of 
setons placed upon the part where the dull sound exists, 
and not always upon the seat of pain ; for it may happen that 
the sound lung may be the more painful, for this reason 
alone, thatitreceives in excess the blood which cannot easily 
traverse the lung compressed by the serous or purulent 



PRACTICE OF MEDICINE. 123 

collection. In this case, the application of a blister upon 
the sound and painful side, would only have the effect of 
developing the tendency to inflammation and of accelerat- 
ing the fatal event. It is then essential to recognise this 
state perfectly, to avoid the commission of such an error 
in the treatment. When the pus has a tendency to open 
its way externally, we practice the operation of empyema; 
but this operation is contra-indicated if pneumonia ex- 
ists simultaneously with pleurisy, if the lung be tubercu- 
lous or hepatized, a state which we recognise by the ex- 
istence of fever with exacerbations, a circumscribed red- 
ness of the cheeks, &c; it is likewise contra-indicated 
when there is dropsy, hypertrophy of the heart, and a 
violet colour of the lips. The only case in which expe- 
rience has demonstrated the advantage of operating, is that 
in which the dull sound is very circumscribed. 

We shall likewise endeavour to arrest the infiltration 
which makes its appearance in the eyelids, in the feet,&c; 
for this purpose we shall add to the means pointed out, 
the diuretics, such as the nitrate of potash, the juniper 
berry, squills, the mild purgatives; but we must always 
pay attention to the state of the digestive organs. 

If the acute stage supervenes upon the chronic, we em- 
ploy antiphlogistics as in acute pleurisy. 

The complications of gastritis exact precautions in the 
use of aliments and of all the internal medicines. 

Pneumonia, to which pleurisy leads but too often, ag- 
gravates the disease, but does not require a particular 
treatment. 

If there be hypertrophy of the heart, it must be treated 
by leeches, absolute rest, diet more or less severe, and by 
digitalis, if there be no gastritis. 



124 THE PHYSIOLOGICAL 



CHRONIC PERICARDITIS. 



This affection is more rare than pleurisy; it exists 
with or without an effusion; in the latter case it is called 
"dry." Sometimes we find after death the pericardium 
glued to the heart; we likewise find it sometimes thick- 
ened, lardaceous; we meet with an albuminous secretion 
in its cavity. These are so many products of irritation. 

Symptoms. 
Permanent pain in the region of the heart; dyspnoea; 
sometimes a dry cough; pulse small; accelerated; palpita- 
tion produced by the slightest exercise; suffocation; pu- 
sillanimity; fear of death; dull sound over the region of 
the heart, if an effusion has taken place; in this case there 
is also fluctuation produced by the displacement of the 
liquid. 

The most ordinary are cold; the moral affections; a 
preceding acute affection; wandering rheumatic affections; 
external violence. 

Prognosis. 
It is more serious when there is a dull sound and fluc- 
tuation, and when symptoms of dropsy supervene, swelling 
of the feet, and bloated visage, &c. than when it is dry. 
The patient may die immediately, or perish in marasmus, 
after many months, or even years of suffering. 

Treatment. 
It is exactly the same as that of chronic pleurisy. Ab- 
solute rest must be enforced. 



PRACTICE OP MEDICINE. 125 

CHRONIC PNEUMONIA. 

Phthisis Pulmonalis. 

After having treated of pulmonary catarrh, and of pleu- 
risy, both acute and chronic, we are in a better condition 
to comprehend chronic pneumonia. We have seen that 
irritation of the bronchial mucous membrane, and of the 
pleura often extends to the areolar tissue of the lungs; we 
have seen also that acute pneumonia may pass into the 
chronic state like all other inflammations. The know- 
ledge of these diverse phlegmasias is then a great step to- 
wards an acquaintance with the disease we have just en- 
tered upon. Whatever may have been the commence- 
ment of this malady, dissection constantly presents nu- 
merous traces of disorganization, tubercles, granulations, 
cavities, abscesses, melanosis, hepatization, encephaloid 
masses, sometimes a destruction, almost complete, of the 
lung by suppuration. 

Authors have never well understood chronic pneumo- 
nia, if we are to judge by the theories which they give, 
and the numerous classifications they establish. In this 
affection they beheld a specific malady, which they called 
phthisis, and of which they had many forms, without any 
other foundation than the predominance of particular 
symptoms, or the organic lesions found after death. Thus 
there were tuberculous, rheumatic, catarrhal, ulcerated, 
melano'i'd, granulated, &c. phthisis. But the physiologi- 
cal physician, who knows that these diverse kinds of dis- 
organization are constantly the product of irritation; that 
this determines sometimes tubercles, sometimes melano- 
sis, sometimes hepatization, &c. according to the constitu- 
tion of the individual; the precise seat of irritation; its in- 
tensity, &c. &c. will guard against taking the effect for the 
cause, and entertaining the belief of a specific disease. 
Whether it advances rapidly towards disorganization, or 
17 



126 THE PHYSIOLOGICAL 

whether it passes through its stages slowly, and in a manner 
almost imperceptible ; whatever may be the form it as- 
sumes, its nature is always identical ; it is an irritation, a 
phlegmasia of the pulmonary tissue. The name of chro- 
nic pneumonia is therefore preferable to pulmonary phthi- 
sis, because it better expresses the character of the dis- 
ease. 

Chronic pneumonia may present itself under forms ex- 
tremely different, which may render the diagnosis difficult; 
but as they give rise to certain symptoms which are always 
met with, and which are, so to speak, pathognomonic, we 
shall never be led into error. 

There is primitive and consecutive chronic pneumonia. 
The first is that which has been preceded by neither ca- 
tarrh, pleurisy, nor acute pneumonia; the second is that 
which has been preceded by the acute stage, but it is sel- 
dom that chronic pneumonia comes on, unless there has 
previously existed a slight cough occasionally, or a pulmo- 
nary catarrh, to which no attention has been given. In- 
sensibly this irritation of the bronchia gains the lungs, 
gives rise to the formation of tubercles, and it is then said 
that these tubercles exist without previous irritation, and 
that the phthisis is an essential disease. As it would be 
tedious and useless to describe here the numerous forms 
of chronic pneumonia, we shall confine ourselves to the 
most common, as giving the type by which we may re- 
cognise all other cases. We shall speak of primitive 
pneumonia, called essential phthisis, and of chronic pneu- 
monia succeeding an acute phlegmasia. 

Symptoms of Primitive Chronic Pneumonia, called 
Essential Phthisis. 
It is preceded by a greater or less number of the symp- 
toms which we are about to enumerate: slight fever, aug- 
mented by the least exercise; burning heat; dryness of the 



PRACTICE OF MEDICINE. 127 

palms, particularly towards the decline of day; humidity 
of the eyes after sleep; abundant urine; circumscribed 
redness of the cheeks; hoarseness; slight or intense pain 
in the back; in the chest; sometimes a point in one or both 
sides is affected with a dull or a lancinating pain; head- 
ache; frequent fainting; lassitude or general inaptitude for 
exercise or motion. In a short time supervene symptoms 
that leave no doubt as to the nature of the malady; these 
are a slight irritation of the larynx; cough more or less 
violent; hoarseness of the voice; a feeling of weight and 
of constriction in the chest, particularly after motion; 
sometimes haemoptysis; difficult decubitus on one of the 
sides; respiration short, accelerated, accompanied with a 
sense of suffocation after walking or ascending stairs; the 
cough increases towards the decline of day; during the 
night it is rending and followed with mucous and puru- 
lent expectoration. These signs are accompanied by wan- 
dering pains in the cavity of the thorax, and with considera- 
ble lassitude. The temper of the patient becomes peevish, 
the appetite diminishes more and more, and it is not un- 
common for vomiting to occur after eating; the body be- 
comes considerably emaciated ; the expectoration becomes 
more abundant, and the matter expectorated is purulent, 
yellowish, greenish, sometimes mixed with bloody striae. 
Hectic fever supervenes with exacerbation in the evening, 
in the following manner: ordinarily there is a sensation 
of languor and chilliness before the febrile exacerbation, 
which increases during some hours; the pulse is much ac- 
celerated, the skin is burning, the cough is dry and fre- 
quent; this febrile heat is succeeded by profuse night 
sweats; the urine deposits a lateritious sediment, and 
the symptoms then diminish in intensity. Percussion 
gives a dull sound over an extent more or less consi- 
derable; the cylinder no longer transmits the murmur of 
respiration over the points where the sound is dull, be- 



128 THE PHYSIOLOGICAL 

cause the lung being tuberculous, hepatized, affected with 
abscess, has become impermeable to the air; the tongue 
and the whole mucous membrane of the mouth are red, 
or covered with aphthae; a cadaverous paleness overspreads 
the whole visage, with the exception of a very circum- 
scribed spot on the cheeks. As the disease proceeds to- 
wards its termination, the emaciation becomes frightful, 
the eyes assume a pearly lustre; a colliquative diarrhoea 
supervenes, which indicates that the irritation has gained 
not only the stomach, but also the colon; sometimes there 
is oedema of the feet, a falling of the hair, the nails be- 
come curved, every effort of coughing menaces suffoca- 
tion, and finally death terminates the painful scene. 

In this nomenclature, the symptoms really pathognomo- 
nic are pains in the chest, the circumscribed redness of 
the cheeks, the hectic fever, the dull sound, the absence 
of respiration in the affected points as discovered by the 
cylinder ; the cough and the nature of the expectoration. 
In some more obscure shades of the disease, we only find a 
simple cough, little or no fever, the complexion is sallow, 
but the patient emaciates and wastes away; there is in 
this case almost always lesion of the digestive organs. To 
discover the pulmonary affection, we must use percussion 
with much care, and employ the cylinder. Our examina- 
tion discovers a dull sound, we do not hear the passage of 
the air, the corresponding ribs have no motion; we can 
then pronounce that pneumonia exists although there may 
be no purulent sputa, no fever, no hectic flush, no other 
sympathetic signs: but these symptoms soon supervene in 
the course of the disease. 

Symptoms of Chronic Pneumonia, Consecutive to the 
Acute State. 
In the greatest number of cases chronic pneumonia has 
been preceded either by acute catarrh, acute pleurisy, or 



PRACTICE OF MEDICINE. 129 

acute pneumonia. We may say that these three kinds of 
irritation lead almost constantly to chronic pneumonia, 
when they are prolonged for any considerable time. These 
commemorative symptoms render then the diagnosis of 
this disease very easy. We are assured that the irritation 
of the bronchia, or pleura has invaded the lungs, or that 
the acute pneumonia has become chronic, when the pains 
persist, or manifest themselves in the chest, when there 
is circumscribed redness of the cheeks, a small continued 
fever, (hectic,) a dull sound and absence of respiration to 
a greater or less extent, indicated by the cylinder, im- 
mobility and depression of the ribs over the affected part, 
cough, with purulent expectoration. When catarrh has 
preceded chronic pneumonia, it is the upper part of the 
lung which is first affected: when it succeeds a pleurisy, 
it is the part corresponding to the pleuritic point. These 
signs, which we may call infallible, are accompanied with 
the same sympathetic symptoms as those which manifest 
themselves in the course of primitive chronic pneumonia 
in an advanced stage. When disorganization has taken 
place, when there are tubercles, hepatization, cavities, 
suppuration, &c. the symptoms are absolutely the same, 
and confound themselves completely, no matter what may 
have been the commencement of the disease. 

In the course of pneumonia, it is not uncommon to ob- 
serve the appearance of different cutaneous affections, 
such as erysipelas, furuncles, miliary eruptions, fistula in 
ano, &c. but these eruptions do not arrest the progress of 
the disease, when disorganization has commenced. 

Gastritis and gastro-enteritis almost always supervene 
on chronic pneumonia, when the disorganization is far 
advanced; there is then loathing of food, or an inereased 
appetite, and all the symptoms of gastritis attended always 
with pains of the stomach after a repast ; there is, like- 
wise, constipation, but the irritation of the intestines tra- 



130 THE PHYSIOLOGICAL 

vels at a more advanced stage to the colon, producing diar- 
rhoea, followed in a short time by death. 

Chronic pneumonia may be exasperated by different 
causes, particularly by cold; it may assume the acute form 
and rapidly carry off the patient, or become chronic and 
acute alternately for a succession of times. 

Between these two well-marked shades of chronic 
pneumonia, there exist many others more or less obscure, 
but which may easily be recognised by comparing them 
with the descriptions we have just given. 

Causes. 
Consecutive chronic pneumonia recognises for its cause 
the acute phlegmasia which has preceded it. Primitive 
chronic pneumonia, the essential phthisis of authors, may 
be determined by all the irritating and stimulating causes 
which act upon the lungs. But whatever may be said, 
phthisis never comes on ex abrupto, and if we pay close 
attention to the subject, we shall always find that it has 
been preceded by catarrh, more or less slight, appearing 
and disappearing at intervals, by cough, by complaints of 
the throat, by slight pains in the back, &c. but as no at- 
tention is paid to these symptoms, when they are slight, 
it is said that tubercles, that granulations, or miliary tuber- 
cles existed in the lung before inflammation, and that the 
latter is a result of these organic alterations, and that 
phthisis is consequently a malady, sui generis, which 
can neither be foreseen nor arrested in its progress. Hap- 
pily this discouraging theory is erroneous ; organic alter- 
ations, of whatever kind they may be, are always the effect 
of an irritation which has preceded them; but tubercles, 
granulations, pus, &c. once formed, become so many 
foreign bodies, which irritate the neighbouring parts, 
augment the irritation which has given rise to them, and 
hurry on the disorganizing process. Let it suffice to 



PRACTICE OF MEDICINE. 131 

notice this as a fact, as the limits of this work do not 
permit us to enter into a detail of the numerous proofs 
which render it incontestible. 

Besides the occasional causes of chronic pneumonia, 
which are all the agents which excite, stimulate, or irri- 
tate the organs of respiration, and consequently the same 
as those of acute pneumonia, there are predisposing causes. 
Predisposition consists in a peculiar irritability of the lung, 
which renders it more sensible to the impression of irri- 
tating agents, and, consequently, more apt to contract 
irritation. There is no age, no sex, no temperament 
which may not be affected with pneumonia; but experi- 
ence has demonstrated that the predisposition, the pecu- 
liar irritability of which we speak, is most frequently 
found among individuals who have the constitution which 
has been named phthisical, the characters of which are 
the following : narrow chest, long and small neck, slen- 
der limbs, a tall thin stature, delicate skin, circumscribed 
redness of the cheeks, the lymphatico-sanguine tempera- 
ment. The scrofulous constitution, likewise, gives a pre- 
disposition to tubercles, and, consequently, to chronic 
pneumonia. As the organic structure transmits a heredi- 
tary character, it results that, in the same family we may 
often encounter the same irritation derived from this 
cause, or, which is the same thing, we meet with a pre- 
disposition to the same maladies. It does not, however, 
follow that these individuals are irrevocably condemned 
to contract the diseases of their parents ; but to secure an 
exemption from them, they must avoid the influence of 
the occasional causes more carefully than individuals not 
predisposed. Unhappily the predisposition, or, to speak 
with more accuracy, the irritability may be such that 
even the influence of the agents necessary to life may de- 
termine inflammation. Singing, declamation, residence 
in a cold climate, &c. may not injure a chest which has 



132 THE PHYSIOLOGICAL 

but little irritability, whilst the same causes prove de- 
structive to lungs eminently irritable, such as are pos- 
sessed by persons of the phthisical habit of body. 

We have said that gastro-enteritis developes itself often 
during the course of pneumonia, but it is not uncommon 
also for the gastritis to exist antecedently to the pulmonary 
affection; it should then be regarded as the cause of chro- 
nic pneumonia. It is essential to keep in view that these 
two irritations are often concomitant from the commence- 
ment to the termination of the disease. 

Prognosis. 
It is very unfavourable when the dull sound, and con- 
sequently disorganization extends over a large part of the 
lungs. In other respects we can judge of the intensity of 
the disease by the violence of the hectic fever; by the na- 
ture of the sputa; the violence and perseverance of the 
cough; and the emaciation always progressive of the pa- 
tient. 

Treatment. 

This is emphatically the place for the application of the 
maxim, ' principiis obsta.' The essential point is to arrest 
the inflammation, as this is the only means of preventing 
disorganization. 

Chronic pneumonia being generally the result of catarrh, 
of pleurisy, or of acute pneumonia, care should be taken 
to dissipate in proper time these inflammations, in treating 
them appropriately by the means pointed out. (See these 
articles. ) 

As primitive chronic pneumonia comes on in a manner 
more insidious, it is important to be on our guard at a 
seasonable period against those little rheums, those slight 
temporary coughs, which announce the commencement of 
irritation, and which would not degenerate so often into 



PRACTICE OF MEDICINE. 133 

chronic pneumonia, even among the predisposed, if there 
was less carelessness about opposing them by a proper 
treatment. In the treatment, the removal of the occasional 
causes should be considered of the first importance; thus 
subjects of a phthisical habit, those who have great pul- 
monary irritability, should make up their minds to prac- 
tice self-denial in a great many things. They should 
avoid the vicissitudes of heat and cold, singing, hollowing, 
declamation, stimulating food and drink, &c. Beside this, 
if these individuals have a cough; a catarrh, however 
slight; pains in the back; behind the sternum, no matter 
how well they may be in other respects; they must be 
put upon a severe diet; and these irritations must be at- 
tacked from time to time by small general and topical 
bleedings, whilst they have sufficient strength to endure 
them. These same means are applicable to those who 
have just had an attack of haemoptysis, and who still re- 
tain heat; a circumscribed redness of the cheeks, and a 
cough with the 'rate maqueux' in the chest. In all cases, 
before the fever is continued, and before the dull sound 
exists, we must commence with a general bleeding, apply 
leeches, sometimes repeatedly, immediately over the point 
of inflammation; afterwards emollient cataplasms; a mild 
diet, of milk, if the stomach supports it well; if not, we 
give water gruel, pap, three or four ounces of broth, two 
or three times a day ; the inflammation having been en- 
tirely dissipated by these means, we must prevent its re- 
turn. Here also the only means consist in the removal 
of all the occasional causes; if there is a tendency to re- 
lapse, we must resort to the employment of the revulsives, 
which consist of moxa, setons, blisters, or cpispastic oint- 
ment; we continue the emollient regimen with persever- 
ance; avoid the impression of cold during the winter, 
and all exposure to its influence when there is moisture 
18 



134 THE PHYSIOLOGICAL 

of the skin. The patient must live in an artificial atmos- 
phere during the bad season. 

Should the dull sound and continued fever supervene, 
or persist, notwithstanding the employment of these 
means, we must renounce bleeding, and if the patient has 
appetite, allow him a more liberal diet, for if we persevere 
many months in bleeding, and in the use of too severe a 
diet, the debility would become too great, and the strength 
of the patient be exhausted. But moderation must be ob- 
served in the quantity and quality of the food; if too much 
is taken, and if it be too exciting, we immediately observe 
an aggravation of all the symptoms, and particularly of 
the fever. 

If the revulsives placed upon the chest occasion cough, 
and cause the loss of sleep, we dress them with emollient 
applications. 

When the disease is far advanced, the cough violent, 
and the expectoration very abundant, to such a degree a» 
to prevent the patient's sleeping, the repast of the even- 
ing must be omitted, and a mucilaginous draught, with 
the addition of opium, of laudanum, or of the acetate of 
morphia, be administered. 

If the stomach is sound, the Iceland moss may be given 
in the form of jelly, or in infusion, and even small doses 
of the sulphate of quinine; but these medicines must be 
laid aside on the slightest appearance of gastric irritation. 
When profuse sweats exhaust the patient, it has been 
proposed to moderate the secretion by the internal use of 
the acetate of lead in progressive doses, from six to twelve 
grains, during the twenty-four hours. Some have even 
gone so far as to propose this medicine as a means of cure 
in chronic pneumonia; if they can cite examples of its 
successful employment, it has been when there existed 
only chronic catarrh, which has been mistaken for pneu- 
monia. In the cases in which there are tubercles, hepa- 



PRACTICE OP MEDICINE. 135 

tization, &c. what can be expected from these, or indeed 
from any other remedies? 

What shall we say of tartar emetic, so much vaunted by 
some, and so much decried by others? In the beginning 
of the disease, w r hen as yet there is no disorganization, it 
appears to be nearly demonstrated that tartar emetic may 
diminish the inflammatory state by retarding the circula- 
tion of the blood, and in consequence, delay or prevent 
the disorganization, which is the result of it: but these 
two conditions are necessary — there must be a complete 
absence of gastric irritation; and the tartar emetic must be 
given in very small doses; for example, one, or at most 
two grains may be taken in an appropriate vehicle in the 
course of the day, in several doses, in such a manner as 
not to provoke vomiting. If there is a tendency to hy- 
pertrophy of the heart, the digitalis may be advantageously 
conjoined with this medicine. We discontinue the use of 
them on the least appearance of the symptoms of gastritis. 
As to the internal use of tartar emetic in high doses, in 
doses that might be called frightful, as we have seen it ad- 
ministered in our days, reason had already pronounced 
upon it before experience had demonstrated the danger 
of the practice; I do not hesitate to say that in many cases 
the deaths which have followed its use should be regarded 
as the result of a real poisoning. 

When it has reached a very advanced stage, it is a dis- 
ease beyond the reach of the resources of art, and admit? 
only of palliative treatment. 

ACUTE AND CHKONIC CUTANEOUS PHLEGMASIA. 

EXANTHEMATA. 

The skin is often the scat of diverse phlegmasia, botli 
acute and chronic, the form of which is extremely varia- 



136 THV. lmvsTOT.omrAT, 

ble. Inflammation may be circumscribed and partial, or 
occupy the whole extent of the skin. It may confine ifr- 
self to the surface, or it may affect its whole thickness, 
and even the subjacent cellular tissue, putting on the 
phlegmonous character. Sometimes its march is very ir- 
regular, at other times it pursues a definite course, appear- 
ing always in a determined form, and disappearing to re- 
turn no more: such are variola, rubeola, &c. There are 
cutaneous inflammations which have a gangrenous charac- 
ter from the commencement; in other cases gangrene does 
not manifest itself until the inflammation has gradually 
reached the highest point of intensity. 

The cutaneous phlegmasia? exercise the greatest influ- 
ence over the actions of the viscera, and principally over 
those of the mucous membranes, and vice versa, on account 
of the close sympathy which connects these parts of the 
body with each other. One class of these diseases awakes 
principally the action of the mucous membrane of the di- 
gestive canal, they occasion the irritation of this mem- 
brane, or are preceded by it. Another class has more re- 
lation to the mucous membrane of the air passages, with 
that of the nose, the eyes, &c. 

Although every phlegmasia of the skin may assume the 
acute or chronic form, there are certain varieties which 
seem particularly to affect the chronic character; such are 
most frequently tetter, tinea, leprosy, &c. Irritation of 
the skin must necessarily deprave its action. There is 
first an afflux of blood and of other fluids towards the ir- 
ritated point; if the inflammation is intense, there may be 
suppuration. At a less violent degree, either because the 
inflammation is fixed for a long time on the same tissues, 
or because the irritation occupies particularly the excretory 
or secretory canals, the nature of the secretions is vitiated 
in such a manner that there exudes from the skin a matter 
which is greasy, oily, ceruminous, gummy, scurfy, scaly, 



PRACTICE OP MEDICINE. 137 

or furfuraceous, &c. All these products are the results of 
irritation; the difference of their forms depends on the in- 
timate structure of the tissues in which they have their 
seats, or on the circumstance of the irritation predominat- 
ing in eertain systems of this tissue, or it depends on the 
intensity of the irritation, or finally on the constitution 
of the individual. But this variety of forms is not op- 
posed to the identity of the nature of the irritation: in 
whatever manner it is contemplated, it can never he any 
thing but an exaltation of vital activity, of which the 
effects must necessarily differ, in consequence of the rea- 
sons we have mentioned above. 



FURUNCLE AND ANTHRAX. 

A circumscribed phlegmonous inflammation of the skin, 
and of the subjacent cellular tissue. 

Symptoms. 
Pruriency, circumscribed renitent redness, pungent 
pain; then follows the eruption of a little red pimple, ac- 
companied with pungent heat. This is the commence- 
ment of furuncle. This pimple soon becomes a tumour, 
which takes the name of furuncle when it is not very 
considerable, and when it rises to a point; it assumes the 
name of anthrax when it is of greater extent. The sum- 
mit of this tumour generally presents one or more grayish 
or blackish points. The inflammation is sometimes suffi- 
ciently violent to give rise to fever. At the end of a few 
days suppuration is established, and we perceive in the 
middle of the inflamed part a whitish mass, which is call- 
ed the corn, and which is nothing else than disorganized 
cellular membrane. In anthrax there may be several of 
these points of disorganized cellular membrane, each of 
which has a particular aperture. Sometimes the intervals 



138 THE PHYSIOLOGICAL 

which separate these points become gangrenous, and there 
results a loss of substance more or less considerable. 

Causes. 

Every thing that causes irritation of the skin; a parti- 
cular disposition to contract these inflammations. This 
disposition is sometimes such, that we see furuncles reap- 
pearing upon different points, during months, and even 
years; this happens particularly under the influence of 
great heat or humidity. 

These inflammations are not unfrequently real metas- 
tasis or transfers of internal irritation to the periphery 
of the body; in this case the internal inflammation is the 
true cause of the external, and this critical eruption may 
prove advantageous. 

Prognosis, 

It is in general by no means unfavourable. 

Treatment. 

We may completely arrest the development of this in- 
flammation by making at the commencement a longitudi- 
nal or crucial incision. If the patient is afraid to submit 
to this operation, we must be content to cover the part 
with the onguent de la mere,* or with diachylon. If it is 
very large, after having applied the plaster, we should 
cover it over with an emollient cataplasm. When the 
core is formed, we should hasten its discharge by using a 
suitable degree of pressure. When furuncles reproduce 
themselves, we must destroy them by cauterizing them 
immediately on their appearance, with the nitrate of silver. 
Emollient drinks must be used if there be fever; no pur- 

* A plaster composed principally of litharge, suet, olive oil, wax, 
and black pitch. 



PRACTICE OP MEDICINE. 139 

gatives or emetics are to be administered under pretext 
of evacuating the humours. 

CARBUNCLE, OR PTJSTULA MALIGNA. 

Carbuncle and the pustula maligna are a sort of furun- 
cle which terminates rapidly in gangrene, and which is 
often accompanied with an internal phlegmasia. 

Symptoms. 
Pain, pruriency, a spot at first red, afterwards black, 
which is soon surmounted by a vesicle encircled by an 
cedematous swelling. The vesicle becomes blackish ; the 
limb is affected with convulsive movements ; this consti- 
tutes pustula maligna. The phenomena which accompany 
the carbuncle are nearly the same ; but generally there is 
no vesicle, and the part surrounded by a certain shining 
redness, is less regular than in the malignant pustule. The 
inflammation promptly disorganizes the subjacent tissues. 
If the patient does not succumb, the eschar detaches itself, 
and there results a loss of substance, which sometimes ex- 
tends even to the bone. In the greater number of cases 
there supervene grave symptoms; to the whole of these 
symptoms grouped together, authors give the name of 
putrid fever; it is a real gastro-enteritis which has arrived at 
the state of adynamy, or ataxy, and which, in a short time 
carries off the patient, if he is not very promptly relieved. 

Causes. 
This affection is contagious. Although it may deve- 
lops itself spontaneously, yet in the greater number of 
cases it is produced by contact with dilfercnt parts of ani- 
mals that are suffering from carbuncle, or have died of it; 
thus the persons most liable to contract it are veterinary 
surgeons, butchers, graziers, tanners, carders of hair for 
mattresses. 



.40 THE PHYSIOLOGICAL 



Treatment. 



Antiphlogistics and tonics, used internally and exter- 
nally, have been lauded in their turn; but experience is 
not in favour of these modes of treatment; and after all 
the trials that have been made, we are obliged to confine 
ourselves to the following plan. Scarifications more or 
less profound, the application of caustics to the tumour to 
limit its extent; some physicians extirpate the entire mass 
with the bistoury. As to the internal treatment, it must 
be as in gastro-enteritis, proportioning the means to the 
intensity of the symptoms. (See gastro-enteritis and its 
different forms. ) Many examples are cited of cures pro- 
duced by the decoction of oak bark, and we are assured 
that, applied externally, this substance arrests the pro- 
gress of gangrene and puts an end to all the danger in the 
course of two or three days. The bark of a particular 
species of oak has been made use of, but it does not ap- 
pear that it acts differently from the other astringent 
barks, the properties of which are owing to the tannic 
which they contain. 

PARONYCHIA. 

Symptoms. 
This is an inflammatory tumour, which developes itself 
at the ends of the fingers or at the roots of the nails; at 
first it is hard and attended with little pain, it afterwards 
becomes red, causes a very acute throbbing pain, and ter- 
minates in suppuration. Although the nature of parony- 
chia is always identical, it has been divided into several 
species, according as it has its seat immediately under the 
epidermis; in the subcutaneous cellular tissue; in the 
sheaths of the flexor tendons of the fingers; in the perios- 
teum, and even in the osseous system. This inflammation, 



PRACTICE OF MEDICINE. 141 

according as it affects the mass of these tissues, and ac- 
cording to the depth of the seat which it occupies, and its 
intensity, may determine swelling of the arm and of the 
axillary glands, violent pains in these parts, intense fever, 
and even death. The latter termination, however, is rare. 

Treatment. 

If the paronychia is slight, if for example, it is of the 
first species, having its seat immediatelyunder the epider- 
mis, we may cure it by immersing the finger in cold wa- 
ter for a sufficient length of time to prevent reaction, or 
even by cauterizing it in the commencement with nitrate 
of silver. Butif theinflammationbe intense,and especially if 
it be deep, we shall almost always succeed in dissipating it by 
repeatedly covering the finger with leeches, a means much 
less painful than laying it open, to which, however, we 
must resort, if local bleeding be ineffectual. The employ- 
ment of plasters and ointments only serves to waste time 
and to give the inflammation an opportunity of producing 
disorganizations, which may necessitate the amputation of 
the finger. 

A mild and light regimen, emollient drinks, abstinence 
from stimulants. 



ERYSIPELAS, ERYTHEMA, ZONA. 

This is a partial phlegmasia of the skin, of greater or 
less extent, sometimes affecting only its surface, at other 
times interesting its whole thickness, and even the subcu- 
taneous cellular tissue. 

Symptoms. 
Erysipelas. — A bright red colour of the skin preceded 
by all the symptoms of gastritis, as general uneasiness, las- 
situde, pyrexia, &c; the second or the third day a slight 
19 



142 THE PHYSIOLOGICAL 

tumefaction of the skin, unevenly circumscribed, with 
redness disappearing under the pressure of the fingers, 
burning heat and pain, affecting most frequently the face, 
sometimes the limbs, and more rarely the other parts of 
the body. Unequal in its forms, erysipelas sometimes oc- 
cupies the whole face, sometimes it spreads successively 
over different parts, producing often complete occlusion 
of the eyes, a fever more or less ardent, and proportioned 
to the intensity of the inflammation. 

At the end of six or seven days there is an eruption of 
serous pustules, and then follows desquamation between 
the ninth and twelfth day. This inflammation may like- 
wise terminate by resolution, by delitescence, by metas- 
tasis, by gangrene or ulceration of the part, and by death. 
Erysipelas is ambulatory or fixed, continued or periodical. 
Erythema. — We give particularly the name of erythe- 
ma to an inflammation of the same nature and of the same 
form as the preceding, when it is produced by an external 
cause. It only differs on account of its having less inten- 
sity, and being, in consequence, rarely accompanied with 
fever. 

Zona. — This is a prurient pustular erysipelas, in form 
of a girdle or of a half girdle, generally occupying the in- 
ferior part of the thorax, or the upper part of the abdo- 
men, and sometimes, but rarely, the neck or the limbs. 
It may or it may not be attended with febrile symptoms, 
according to its degree of intensity. It may exist in a pe- 
riodical form. 

Erysipelas has been distinguished into erysipelas from 
an internal and from an external cause, and also into 
phlegmonous and oedematous erysipelas. These divisions 
need not be explained. 

Causes. 
Acrid, irritating applications to the skin, stings, fric- 



PRACTICE OF MEDICINE. 143 

tion, insolation, heat, cold, the predominance of the san- 
guineous capillary system, the suppression of an habitual 
evacuation, strong moral affections. Erysipelas very often 
depends on internal causes. The most frequent of these 
causes is a gastric irritation. The appearance of the exan- 
thematous eruption sometimes causes the disappearance of 
the internal irritation; but sometimes the cutaneous irrita- 
tion is superadded, and the danger is augmented. There 
is no such disease as bilious erysipelas, but there may ex- 
ist at the same time a superabundance of the biliary se- 
cretion, occasioned by the gastritis. 

We must rank among the internal causes of erysipelas, 
the use of certain aliments, and the ingestion of certain 
poisons, which at first produce irritation of the digestive 
tube, and afterwards a cutaneous eruption or an erysi- 
pelas. 



Violent fever, accompanied by coma or constant deli- 
rium, is a bad omen. Where this is not the case, the ter- 
mination is happy. 

Treatment. 
If the erysipelas is slight, and depends upon an exter- 
nal cause, without fever, local bleeding around the inflam- 
ed part, and never upon the part itself; emollient and re- 
frigerant topical applications. The application of astrin- 
gent substances conjoined with narcotics are then very 
useful. If the irritation is intense, emollient fomentations 
and a mild unirritating regimen. If the patient is pletho- 
ric, general blood-letting, and severe diet, even should the 
erysipelas be but slight. If the irritation has been preced- 
ed by internal irritation, the same treatment must be used; 
all internal stimulants should be proscribed; demulcent 
drinks are to be administered. If it is accompanied with 



144 THE PHYSIOLOGICAL 

gastric irritation, or with a secretion of bile, no emetics 
are to be employed, but the treatment of gastritis, with 
more or less energy, according to the violence of the symp- 
toms, is to be superadded to that of erysipelas. If there is 
prostration of strength, smallness of the pulse, it is no 
longer proper to bleed; nevertheless, we must not admi- 
nister bark, musk, or other pretended tonics. In phleg- 
monous erysipelas, after this treatment, we make inci- 
sions to evacuate the pus. When pustules supervene, we 
puncture them and apply emollients. 

N. B. Some practitioners are in the habit of applying 
a large blister over a severe erysipelatous inflammation 
in its commencement, for the sake of dissipating it; this 
practice is often crowned with success; but the particular 
irritability of the individual should be taken into consider- 
ation by the physician, for there are some, in whom the 
addition of this artificial irritation may react upon the vis- 
cera, and aggravate the symptoms. The employment of 
general and local depletion, more or less copious, and 
more or less frequently repeated, according to the cir- 
cumstances of the case, the antiphlogistic diet, regimen, 
and drinks will, in every case, constitute the treatment 
which is most rational and least hazardous. 



SCARLATINA, OR SCARLET FEVER. 

This affection has for its principal characteristic an erup- 
tion of irregular spots on the skin, accompanied with an 
irritation of the mucous membrane of the digestive canal, 
and still more frequently of the air passages. 

Symptoms. 
They vary according to the complications, and the in- 
tensity of the irritation. If the scarlatina is mild, after 
three or four days of fever, the face swells; at the same 



PRACTICE OF MEDICINE. 145 

time red points make their appearance upon the skin, at 
first scattered, but in a short time close together. About 
eight days after the eruption, there is a desquamation, 
often followed by a general tumefaction, resembling 
anasarca, but generally disappearing in a short time. If 
the irritation be violent, its course is as follows: — There 
is first general uneasiness; rigors; heat; head-ache; sore 
throat; coryza, sometimes of considerable intensity; the 
tongue is red on its borders. The second day deglutition 
becomes difficult; there is swelling of the tonsils; nausea, 
and even vomiting ; the breath is hot; respiration hurried, 
and interrupted by sighs; the skin burning and dry; 
anxiety ; hurried circulation. Such are the precursory 
symptoms to which the name of the fever of incubation 
has been given: this fever is only the sign of a gastric ir- 
ritation, accompanied most frequently with an angina. 
This irritation is sometimes of a nature sufficiently intense 
to develope cerebral symptoms of a very grave nature, 
and sometimes even rises to a state of adynamy and 
ataxy; this is the scarlatina maligna of authors. It may 
invade the lung or the pleura, and be attended with all 
the dangers resulting from the inflammation of these 
parts. 

Towards the third or fourth day, swelling and redness 
of the whole skin, resembling a vast erysipelas, disap- 
pearing under pressure, but reappearing very promptly; 
sometimes* but not constantly, an eruption of spots of a 
scarlet colour, sometimes livid, on the face, the neck, the 
chest, and afterwards over the whole body. General 
oedema, affecting particularly the lower extremities. Des- 
quamation three or four days after the eruption. Scar- 
latina is very often followed by anasarca; at other times 
it leaves a catarrh, a pleurisy, or a pneumonia. These 
results are most apt to occur when the inflammation has 
not been attacked vigorously. 



146 THE PHYSIOLOGICAL 

Causes. 
This complaint selects children and youth particularly, 
as the objects of its attacks, and prevails especially in the 
end of autumn. However, no age is exempt, and it may 
occur in all seasons. It sometimes reigns epidemically; it 
appears to be capable of communication by contact, and by 
inoculation. In general it attacks the same individual but 
once. 

Prognosis. 
Symptoms of adynamy and of ataxy are very ominous. 
The patient may die of suffocation from the swelling of 
the tonsils; the mucous membrane of the larynx may be 
attacked by gangrene; gastritis, pleurisy, or pneumonia, 
when they exist, occasion danger in proportion to the in- 
tensity of these inflammations. Most frequently the dis- 
ease is cured. 

Treatment. 
The same as that of measles. (See Measles.) 



Like scarlatina and variola, is preceded by symptoms 
to which authors give the name of the fever of incubation, 
and which, in the view of the physiologist, are those of 
an irritation of the mucous membrane of the alimentary 
canal, of the pulmonary passages, and sometimes of the 
encephalon. General uneasiness, contusive pains of the 
limbs, alternations of heat and chilliness, nausea, some- 
times vomiting and diarrhoea, most frequently a dry cough 
from the commencement, hoarseness, dyspnoea, somno- 
lence, wild dreams, sneezing, coryza, swelling of the eye- 
lids, and the eyes, a continual flow of hot acrid tears, 



PRACTICE OF MEDICINE. 147 

soreness of the throat more or less violent, sometimes 
irritation of the whole respiratory apparatus, and in 
that case, heat, oppression, and pain in the thoracic region, 
insupportable itchiness of the face; towards the fourth day, 
sometimes sooner, rarely later, an eruption, at first on the 
face, afterwards on the neck, on the chest, and insensibly 
over the whole skin, of little red spots, slightly elevated, 
somewhat like the bites of a flea, and generally grouped in 
irregular patches. The interstices between these patches 
are not of a deep red colour, as in scarlatina, a circum- 
stance which may serve to distinguish this disease from 
the measles. The form of the pustules equally prevents its 
being confounded with variola. The eruption is generally 
completed in from thirty-six to forty-eight hours. The 
symptoms mentioned above, with the exception of vomit- 
ing, subside neither on the accession nor on the completion 
of the eruption; sometimes the fever and the cough grow 
worse, and occasionally the disease may rise to the form 
of adynamy, and it then constitutes the malignant measles 
of authors. Desquamation occurs towards the fourth or 
fifth day after the eruption. There remains yet for a time 
some fever, cough, and very often a rebellious diarrhoea. 

Causes. 
It is contagious; although infancy and adolescence are 
most exposed to it, yet it attacks all ages and all sexes. 
It often prevails as an epidemic, and particularly during 
winter and spring. 

Prognosis. 
When irritation predominates with violence in the di- 
gestive canal, or in the air tubes, and the eruption takes 
place with difficulty, the danger is in proportion to the in- 
tensity of this inflammation. The phenomena of adynamy 
are always ominous. If the visceral inflammation, what- 



148 THE PHYSIOLOGICAL 

ever may be the seat of it, is not considerable; especially 
if the fever diminishes when the eruption makes its ap- 
pearance, or when it is completed, it is a favourable sign. 
Measles may be followed by marasmus, by anasarca, and 
by rebellious diarrhoea, a circumstance which indicates 
that the inflammation remains fixed upon some viscus, 
after the measles has disappeared. 

Treatment of the Measles, and the Scarlet Fever. 

Curative Treatment. — In the beginning, when it is not 
certain that an eruption is about to make its appearance, 
the treatment should be decidedly antiphlogistic. This 
is the only way of preventing the inflammation from 
rising to a very intense degree, of preventing adynamy, 
convulsions, suffocating angina, pneumonia, and pleuritis, 
which are only the effect of this inflammation. Thus, we 
have recourse to blood-letting over the epigastrium, at the 
throat, over the chest, and in every place where inflam- 
mation appears to predominate. General blooH-letting 
must be employed if there is violent pneumonia, or pleu- 
ritis, or encephalitis. We must repeat these means often, 
and with confidence, as long as the symptoms of inflam- 
mation persist, or have a tendency to rise. The patient 
must be placed in a temperate atmosphere. Severe diet, 
warm emollient drinks, hot cataplasms to the inferior ex- 
tremities. 

If the eruption occurs with difficulty, it is proper to 
give sudorifics to throw it upon the skin: if the inflam- 
mation of the digestive organs be intense, which may be 
easily known by the violence of the fever, these drinks 
would only augment it ; we must then confine ourselves 
rigorously to the administration of the mildest drinks, 
such as those of mallows, of gum arabic, or sugar-water. 
But if the inflammation of the stomach is not active, we 
may give hot drinks made with the flowers of violet, of 



PRACTICE OF MEDICINE. 149 

mallows, of elder, edulcorated with the syrup of gum 
arabic The patient is to be placed in a warm bath, and 
immediately afterwards in a warm bed, properly covered; 
we then administer a hot drink, but not stimulating, to 
excite the action of the skin. Some physicians advise the 
employment of the cold bath, and to wrap the patient up 
afterwards in a hot blanket, to provoke vital reaction, but 
unless this reaction occurs, the irritation is infallibly aug- 
mented. 

We do not venture to indicate this means but with 
caution, although it is certainly useful in some cases. 

The eruption being completed, if the fever has dimin- 
ished, we may give chicken water, at a later period thin 
light pottage, afterwards broth, but if the symptoms do 
not become milder, we must persevere to the end in the 
antiphlogistic treatment. 

Preventive Treatment. — The prevention of mediate or 
immediate contact with the diseased. If an epedemic has 
been developed by local causes, removal from the source 
of infection. 

German physicians prescribe belladonna as a preventive 
of scarlatina. They administer the extract in the propor- 
tion of two grains to an ounce of fluid, of which they give, 
four times a day, five or six drops to infants, and ten to 
persons more advanced. We have not had an opportunity 
to test the efficacy of the medicine in this disease. 

VARIOLA, OR SMALL-POX. 

Variola is divided, on account of the manner in which 
the eruption appears, into distinct and confluent, and on 
account of the gravity of the symptoms, into benign and 
malignant. But the nature of the disease is always iden- 
tical. The inflammation may be light or intense, predo- 
minate in certain viscera, develope diverse sympathetic 
20 



150 THE PHYSIOLOGICAL 

symptoms, in proportion to its intensity, and the irrita- 
bility of each individual, but all this constitutes only a 
variety of form. We will then content ourselves with 
describing the two most prominent forms, from which the 
others differ only in being of greater or less intensity, 
viz. distinct or benign small-pox, and confluent or ma- 
lignant. 

Symptoms. 

Distinct or Benign Small-Pox. — Uneasiness, lassi- 
tude, horripilation, pungent heat of the skin, pyrexia, 
pain at the epigastrium, rendered more sensible by pres- 
sure, pain in the loins, nausea or vomiting, somnolency, 
sometimes convulsions, especially among infants. Such 
are the precursory symptoms which constitute the fever 
of incubation of authors, and which are of the same na- 
ture as those of scarlatina and the measles. Towards the 
third or fourth day, an eruption of small red points, at 
first little elevated, separated by interstices, more or less 
considerable, appearing at first upon the face and upon the 
chest,and successively, but sometimes simultaneously, over 
the other parts of the body. A diminution of all the fe- 
brile symptoms during the eruption, entire apyrexia when 
it is completed, which happens in the space of four-and- 
twenty hours. The pustules increase then in volume from 
day to day, rising to an apex; their points at first whitish, 
then yellowish, enlarge afterwards, and present a depres- 
sion; the face and eye-lids are swelled to such a degree 
that the patient often cannot open his eyes. 

Towards the eleventh day, the pustules have attained 
their maximum of volume; they suppurate, burst and dry, 
the swelling of the face disappears, and is often replaced 
by that of the feet and hands. If the eruption is somewhat 
abundant, there is towards the sixth or the seventh day, 



PRACTICE OF MEDICINE. 151 

difficulty of deglutition, hoarse voice, ptyalism, and the 
fever reappears ordinarily from the eighth to the tenth 
day; but all these symptoms disappear when desquama- 
tion occurs. 

The Confluent and Malignant Small-Pox of au- 
thors. — In this variety the eruption is preceded by vio- 
lent pyrexia, attended in many cases with frequent vomit- 
ing, with convulsions, with coma, delirium, an undefina- 
ble uneasiness, sometimes by diarrhoea. The eruption is 
not so long delayed in general as in distinct small-pox; it 
occurs most frequently from the second to the third day. 
The spots are so multiplied and so near each other, that 
it is difficult to perceive the interstices; on the face they 
appear to form only a single sore, with an unequal sur- 
face. After the eruption, the violence of the symptoms, 
with the exception of the vomiting, does not abate; almost 
always it is augmented, there is acute encephalitis, and of- 
ten inflammation attains the degree of adynamy and ataxy. 
The whole face swells in a manner so horrible, that it is 
impossible to recognise a single feature of the patient; de- 
glutition is extremely difficult and painful; there is ptya- 
lism, which in the case of infants is succeeded by diar- 
rhoea. The pustules tend to suppuration, whichoccurs a little 
sooner than in the first variety. Most frequently they fur- 
nish in place of pus, only a sanious humour, and desqua- 
mation does not occur until the twentieth or twenty-se- 
venth day, leaving marks upon the skin more or less deep. 

When the disease is very violent, and the eruption oc- 
curs with difficulty, we sometimes observe on the skin the 
appearance of livid marks; the urine is often bloody; a ge- 
neral erysipelas may precede or follow the eruption. 

Causes. 
This disease is eminently contagious; there is not per- 



152 THE PHYSIOLOGICAL 

haps an example well attested of its occurrence twice in 
the same individual.* 

Prognosis. 
Distinct small-pox, according to the most exact registers, 
carries off about a tenth part of those affected with it, while 
confluent small-pox destroys one-half. A very laborious 
deglutition, particularly if there be great prostration of 
strength, cerebral symptoms, petechial spots of the skin, 
and haemorrhage of the urinary passages, are signs of violent 
inflammation, and consequently are very ominous. Even 
when the disease terminates in health, it often leaves af- 
ter it deformities, such as scars, blindness, spots on the 
eyes, lachrymal fistula, deafness, lameness, &c. 

Preventive Treatment. — Vaccination; inoculation is 
at the present day unanimously rejected. It is proved by 
examples extremely numerous, that individuals vaccinated 
with success, have been affected afterwards with variola. 
The reason of this is, that vaccination does not always de- 
stroy entirely the disposition to contract the small-pox, 
and then the disease may make its appearance in a vacci- 
nated person; it is on this account that in certain coun- 
tries, and particularly in some of the Swiss cantons, it has 
for many years been the custom to practice a second vac- 
cination in children, three or four years after the first. 
There has not yet been an example of the small-pox mak- 
ing its appearance in persons who have submitted to these 
precautions. 

Curative Treatment. — Distinct small-pox only re- 

* The author here undoubtedly is in error; notwithstanding the ob- 
stinate scepticism of some pathologists on this point, the possibility of 
the occurrence of small-pox twice in the same individual, is establish- 
ed on incontrovertible evidence.— Translator, 



PRACTICE OF MEDICINE. 153 

quires confinement to bed in an airy chamber of a moderate 
temperature, emollient drinks, warm, and slightly dia- 
phoretic, if the gastric symptoms are light, abstinence, 
emollient cataplasms to the inferior extremities. If the 
signs of the inflammation of the digestive canal are vio- 
lent, leeches to the epigastrium; leeches about the top of 
the sternum, and at the throat, if the deglutition is suffi- 
ciently embarrassed to demand such a measure. 

The confluent small-pox demands a most energetic 
treatment. We might often prevent the symptoms of ma- 
lignity, of ataxy, of adynamy, if from the very beginning 
we were impressed with the conviction that we have to 
treat a violent inflammation, and that the indication is to 
attack it by a treatment decidedly antiphlogistic in its 
greatest rigour. Thus having placed the patient in the si- 
tuation demanded by the distinct variety, we do not he- 
sitate to make use of local depletion, by means of the ap- 
plication of leeches about the points where the inflamma- 
tion predominates; these points are in general the stomach, 
the throat, and the brain, as we may be readily convinced 
by an analysis of the symptoms. These bleedings should 
be abundant and frequent, but when once complete pros- 
tration has occurred, constituting what authors call ady- 
namy or ataxy, leeches become dangerous; we must then 
renounce bleeding and confine ourselves to the employ- 
ment of drinks of a cooling nature, but not acid, because 
the latter provoke cough. If the eruption takes place with 
difficulty, we should use the precautions which have been 
pointed out in the treatment of scarlet fever and the mea- 
sles. The treatment during convalescence is absolutely the 
same as in the case of gastro-enteritis. 

But tbe violence of (ho inflammation sometimes tri- 
umphs over the best directed efforts; the impotence of our 
resources, so often proved in confluent small-pox, has in- 
duced physicians to oppose it with other means. The ec- 



154 THE PHYSIOLOGICAL 

trotic method has latterly been much extolled. This 
method consists in cauterizing the variolous pustules, (in 
the confluent variety,) immediately on their appearance. 
This means arrests their progress, and as the encephalitis, 
(the most serious symptom of the malady,) is in part the 
effect of the cutaneous irritation reacting violently on the 
brain and other viscera, it follows, that in limiting this 
irritation, we must at the same time arrest the march of 
the encephalitis; and this in effect takes place. Cauteriza- 
tion is performed in diverse manners. Some simply touch 
the pustules with nitrate of silver; others commence by 
opening them with a needle, and cauterize them after- 
wards. The temporary deformity produced by the caute- 
rization never leaves any traces. In addition to the cau- 
terization we apply fifteen or twenty leeches on each side 
of the neck, to attack directly the encephalitis; repeating 
this application during two or three days, according to 
the intensity of the inflammation. The confluent small- 
pox, thus combated, present a very small number of un- 
favourable terminations, which this treatment reduces 
nearly to the proportions of those occurring in distinct 
small-pox. 



VARICELLA, OR VARIOLA VOLATICA. 

After a slight fever, an eruption of distinct pustules, re- 
sembling considerably those of variola, but seldom arriving 
at a state of suppuration. After five or six days, these 
pustules dry and fall without leaving cicatrices. 

Causes. 
Little known. It has been regarded as a variety of 
small-pox, with which it has been confounded; but it is 
not contagious. 






PRACTICE OP MEDICINE. 155 

Treatment. 
This malady scarcely requires medical care. We are 
careful not to exasperate the fever, by withdrawing all 
stimulants; and we add to a light regimen, and even to 
abstinence, if the inflammatory symptoms assume a little 
intensity, the employment of emollient drinks, acidulat- 
ed, &c. 

MILIARY FEVER. 

Symptoms. 
This affection is characterized by the following signs: — 
Sleeplessness; lassitude; sense of anxiety, and embarrass- 
ment in the chest; perspiration of a peculiar odour; itchi- 
ness of the skin, afterwards an eruption at a variable pe- 
riod, of little red or white pimples, having considerable 
resemblance to grains of millet appearing over the whole 
skin, except that of the face. After one or two days, 
each pimple forms a little vesicle, filled with a whitish or 
transparent serosity, which, in a short time runs out. The 
pimple then dries, and the epidermis which covers it, de- 
taches itself in furfuraceous scales. It is seldom that the 
eruption is simultaneous over the whole body; most fre- 
quently it takes place successively, and we observe pim- 
ples rising and disappearing in turns during many days, 
and even weeks. 

Causes. 
It appears that the miliary fever is nothing else than a 
gastro-enteritis, accompanied with a cutaneous eruption, 
in persons of a lymphatic constitution, in hot, humid, or 
marshy countries. This disease sometimes supervenes in 
persons in whom a gastro-enteritis has been exasperated 
by stimulants, in women in child-bed, during the affection 



156 THE PHYSIOLOGICAL 

called milk fever, and who have profuse sweats. This 
affection is not contagious; there is no miliary typhus, as 
we might be led to suppose by certain gastro-enterites, 
elevated to the degree of typhus, and accompanied with a 
miliary eruption, or with petechial spots. 

Prognosis. 
The prognosis is the same as that of gastro-enteritis; it 
is the intensity of the internal irritation to which we must 
look as giving grounds for our hopes or our fears. The 
appearance of petechial spots between the miliary points, 
symptoms of adynamy and ataxy, delirium, and coma, are 
very unfavourable omens. 

Treatment. 
The same as that of gastritis, or of gastro-enteritis, or 
that of women during confinement to child-bed, according 
to the . case and its complications. (See gastro-enteritis.) 
We must favour the eruption not by the employment of 
sudorifics or other stimulants, but by the use of watery, 
emollient, and warm drinks, and by preserving a regu- 
lated temperature around the patient. 

URTICARIA. 

Two days after the ordinary precursory signs of the 
cutaneous phlegmasia, an eruption of prurient points, 
considerably resembling those produced by the sting of 
nettles; these points disappear sometimes in the morning 
to reappear in the evening with fever, intermittent ur- 
ticaria. After the lapse of some days, desquamation un- 
der the form of furfuraceous pellicles. 

Causes. 
This eruption is evidently the result of an irritation of 



PRACTICE OP MEDICINE. 157 

the digestive passages: it is in fact sometimes produced by 
the use of certain kinds of food, as muscles, crabs, &c. 
which irritate the digestive canal; at other times it makes 
its appearance in the train of a gastritis. 

Treatment. 
This affection is ordinarily light, and exacts only the 
employment of emollient drinks, and a light and vegeta- 
ble diet. If the fever is violent, we should conduct the 
treatment as in gastro-enteritis. When periodicity exists, 
after the employment of antiphlogistics, we administer the 
sulphate of quinine. 

PEMPHIGUS. 

Pemphigus, which is rather a rare affection, has, for its 
principal character, the appearance, upon different parts 
of the body, of vesicles filled with a yellowish fluid, of 
variable forms and volume. We see them from the size 
of a freckle to that of the fist. The ordinary concomitant 
or precursory symptoms of cutaneous eruptions, do not 
always occur in this disease, so that pemphigus may or 
may not be attended with fever. At the end of five or 
six days the vesicles break, and permit the serosity which 
they contain to ooze out. A scab is then formed, which 
falls, and sometimes leaves an ulcer difficult to cure, par- 
ticularly in scorbutic, old, or scrofulous subjects. The 
appearance of the vesicles is not always simultaneous; it 
is sometimes successive. 

Causes. 
They are little known. We observe this malady par- 
ticularly in countries that are marshy and humid, and have 
an unhealthy atmosphere. It may depend upon an in- 
ternal phlegmasia, and it is then accompanied with fever, 
21 



158 THE PHYSIOLOGICAL 

more or less intense; or it may depend on a cause, the ac- 
tion of which is confined to the skin, and in that case it 
is without fever. Sometimes this disease assumes the pe- 
riodical form. 

Prognosis. 
It is rather unfavourable among persons of a depraved 
constitution, because there may supervene ulcers difficult 
to cure. Among individuals endowed with a good con- 
stitution, the prognosis is favourable if the vesicles contain 
a limpid and inodorous serosity. When there are fever 
and internal phlegmasia, the prognosis is relative to the 
intensity and the complications of this phlegmasia. 

Treatment. 
Nearly the same as that of the preceding cutaneous af- 
fections: if there is gastritis we have recourse to refrige- 
rant drinks. If the ulcers are benign, we dress them with 
simple cerate; if they are black, of bad aspect, we make 
use of stimulating applications, such as the ointment of 
styrax, the digestive ointment, the solutions of chlorate 
of chalk, or of soda, &c. If the affection is purely local, 
we must endeavour to modify the vitality of the skin 
from the commencement of the eruption, by the applica- 
tion of compresses wet with astringent, alcoholic, com- 
phorated liquids, &c. We employ at the same time sudo- 
rifics. We might in the commencement of the eruption 
try the ectrotic method to dispel the eruption, as is prac- 
tised in variola. If there is periodicity, we must admi- 
nister the sulphate of quinine with the treatment pointed 
out. (See Intermittent Irritations.) 



PRACTICE OP MEDICINE. 159 



CHRONIC PHLEGMASIA AND SUB-INFLAMMATIONS OP THE 
SKIN. 

The almost infinite variety of forms which are assumed 
by chronic affections of the skin, does not prove an equal 
variety in the nature of these affections. Pimples, vesi- 
cles, scabs, thickening of the skin, induration of the cel- 
lular tissue, the enlargement of the bulbs of the hair, &c. 
cannot be regarded but as the product of an exaltation of 
the vital action. This is proved by the fact, that diverse 
alterations take place under the influence of the ordinary 
irritating agents which produce sometimes one form of 
disease, sometimes another; and that certain forms, evi- 
dently inflammatory, such as an erysipelas, are observed 
to degenerate into tetter, and vice versa; it is proved like- 
wise, by the circumstance of an internal inflammation 
changing itself often into an affection of the skin, and re- 
ciprocally, according as the cause acts with more or less 
intensity, and as it acts upon a person predisposed to one 
inflammation rather than another. The difference of the 
products of inflammation is easily explained: the vital ex- 
altation draws the fluids into the organs, or into the tissues 
in which it has its seat; if there be an afflux of blood, we 
have an inflammation; if of the sebaceous humours, we 
have the scabs of tetter and other complaints; if of the 
lymph, there is lymphatic engorgement, &c. It is thus 
that the same cause produces different effects, according to 
the tissue affected, the individual constitution, the predo- 
minance of certain fluids, and the alteration which the ir- 
ritation causes them to undergo. It is not necessary, 
therefore to have recourse to specific maladies, to explain 
this diversity of form, a circumstance of disease which is 
not more surprising when it occurs externally, than when 
it appears internally. 



160 THE PHYSIOLOGICAL 

Are we to conclude, after this rapid glance, that the treat- 
ment must be invariable in all kinds of cutaneous affections? 
By no means; for as certain agents irritate more particularly 
certain organs and certain tissues than others, there are like- 
wise certain agents which act more particularly than others 
in recalling them to their normal state. The fundamental 
part of the treatment will, however, always consist in di- 
minishing the vital energy of the tissue; but we attain 
this end sometimes by emollients, sometimes by revulsion, 
sometimes by exciting the part to a higher degree of ac- 
tion, with the view of advancing the inflammation to its 
highest stage of intensity, as is done by a blister, by cau- 
terization, and by irritating frictions; or with the view of 
changing one irritation into another more easy to cure. 
Our limits do not allow us to develope here these propo- 



psora — ITCH. 

Eruption of little pustules, hard at their bases, the sum- 
mits of which present a transparent vesicle, accompanied 
with an intense itching. This eruption occurs on different 
parts of the body, and principally in the joints of the 
fingers, at the bend of the arm, at the wrists, on the hams, 
on the chest and abdomen, on the internal side of the 
thighs, on the back, and rarely on the face. The itchiness 
is augmented by heat; it may become so excessive as to 
occasion sleeplessness, nervous attacks, and inflammation of 
the viscera. In this last case it may happen that the erup- 
tion disappears; there is a metastasis from the exterior to 
the interior, and, in common language, the itch is then 
said to have gone in, but in reality it is only one irritation 
displacing another. 

Different names have been given to the itch, derived 
from the form under which the eruption presents itself; 



PRACTICE OP MEDICINE. 161 

such are the miliary itch, the canine itch, called thus 
when the pustules are very small and close together; it is 
accompanied in that case with a very intense itching; the 
pustular itch, so named when the vesicles are very large, 
and contain a greater quantity of purulent matter. 

Causes. 
It has been attributed to the presence of an insect called 
Jicarus scabiei or sarcoptes; the evidence of its existence 
is not universally admitted. The partizans of this theory 
not only explain by this means the propagation of the 
itch from one individual to another, but the continual and 
almost unlimited renewal of the pustules in the same in- 
dividual. However this may be, the development of the 
malady is favoured by a want of cleanliness, the fineness 
of the skin, humidity, and by cohabitation with persons 
affected. 

Prognosis. 
When it is not attended to, it may transform itself into 
obstinate tetter or into an eruption of boils; or it may be su- 
perseded by an internal phlegmasia, more or less danger- 
ous according to its seat and its intensity. In the greater 
number of cases it is attended with no danger. 

Treatment. 
External. — The eruption must be made to yield as 
promptly as possible to prevent the degeneration men- 
tioned. The emollient topical applications being useless, 
the plan is to supplant this irritation by another. The 
means which succeed best are in the first place sulphurous 
fumigations; then follow hydro-sulphurous baths and lo- 
tions, washing with soap, the sulphurous, the oxygenated, 
and the mercurial ointments, that made with oxide of 
manganese, the citron ointment. Astringents produce 



162 THE PHYSIOLOGICAL 

likewise the same results, but by diminishing the action 
of the skin, they may increase that of the viscera, and 
produce inflammation there. When we employ frictions, 
it is very useful to join with them the warm bath. Of 
late the chlorides of lime and of soda have been extolled 
as having produced rapid cures. 

Internal. — Light regimen, and abstinence from stimu- 
lants and sudorifics, which might irritate the digestive 
tube, and fix the inflammation there. If, notwithstanding 
these precautions, there supervene a visceral phlegmasia, 
and if at the same time there be a recession of the cutane- 
ous affection, we treat this phlegmasia with emollients, 
with topical or general bleeding, according to the case, 
and establish artificial drains as substitutes for the irrita- 
tion of the skin. 



Symptoms. 

Eruption of conical pimples, almost imperceptible, not 
pustular, congregated closely over the whole surface of 
the skin, and principally upon the chest, the arms, the 
thighs, and the abdomen. The eruption is preceded and 
accompanied by insupportable itchiness, generally con- 
stant, but with exacerbations in the morning and evening. 
In some cases there is complete intermission for some 
hours and even days, then violent attacks for seven or 
eight minutes. The pain and the itchiness sometimes give 
rise to convulsions. 

This malady has been divided into Prurigo formicans 
and Prurigo pedicularis; the first is so denominated on 
account of the itching, which resembles the bites of ants, 
and the second species derives its name from the circum- 
stance of its being kept up by the presence of lice in the 
cutaneous tissue. 



PRACTICE OF MEDICINE. 163 

Causes. 
No peculiar causes distinct from those of other cutane- 
ous affections are known; yet the influence of a warm cli- 
mate may be regarded as favourable to the origination of 
this disease. Although all ages are subject to it, yet in- 
fancy and old age are peculiarly exposed to it. This ma- 
lady has been sometimes confounded with the itch, of 
which it might be only the greatest degree of intensity. 

Prognosis* 

This malady, of which the symptoms are sometimes so 
terrible that authors give it the name of ferox, is often 
incurable; it may drive patients to the commission of 
suicide, give rise to mania, or to serious inflammations 
of the viscera, particularly when it is, as they say, re- 
pelled. 

Treatment. 
The same as that of the itch. To appease the itching with 
saturnine and opiate topics. In prurigo pedicularis, to 
employ mercurial frictions to destroy the insects. Fre- 
quent warm baths, light and mild regimen, emollient 
drinks. If internal sympathies are developed, to treat them 
by appropriate means. 

HERPETIC AFFECTIONS, TETTER. 

Tetter consists in a pustular inflammation of the skin, 
with redness, heat, itchiness. The pustules burst, and 
their desiccation gives rise to the formation of scabs of 
different kinds, or to ulcerations, according as the irrita- 
tion of which they are the product, is superficial or pro- 
found, intense or light, or as they predominate in certain 
tissues of the skin, which are so many circumstances ne- 



164 THE PHYSIOLOGICAL 

cessarily leading to diversity in the nature and quantity 
of these morbid secretions. 

Symptoms. 
Although tetter presents itself under forms extremely 
varied, we may nevertheless refer them to a common type, 
by taking for our guide the inflammation of which they 
are the result. Thus generally after an itchiness more or 
less incommoding, after a tumefaction resembling that of 
erysipelas, upon a surface of the skin generally limited, 
there is an eruption of little pustules, distinct or con- 
fluent, permitting the escape of a serosity more or less 
abundant, which concretes sometimes into furfuraceous 
plates, sometimes into scales of different sizes, and some- 
times into dry or humid crusts, varying in depth and ex- 
tent. Sometimes in this disease a scab covers an ulcer of 
greater or less depth, or this ulcer remains open, is red, 
and obstinate, tending more and more to invade the 
neighbouring parts. Hence the name of furfuraceous, 
squammous, crustaceous, pustular, &c. tetter. There are 
likewise many other varieties of tetter to which authors 
have given different names, and which we think it useless 
to enumerate, as these divisions can be founded only on 
difference of form, and not upon a difference of the mor- 
bid process. Tetter is fixed and ambulatory, or serpi- 
ginous; it may return periodically at certain seasons of 
the year; its course is generally chronic; it may be super- 
seded by internal affections more or less serious; these are 
the cases of metastasis, which they improperly call tetter 
struck in, or repercussed. 

Causes. 
Tetter developes itself under the influence of an inter- 
nal or external inflammation, or in consequence of the si- 
multaneous existence of both, and its diverse forms are 



PRACTICE OP MEDICINE. 165 

only the result or product of an inflammation more or less 
intense. The variety the least inflammatory is thefurfura- 
ceous tetter, or the herpes farinosa; but if it be irritated, 
it will become the squammous tetter; this, by irritation 
may assume the pustular form with redness; the pustular 
in its turn may lead to the corroding herpes, which is the 
highest degree of herpetic inflammation. These varieties 
likewise depend often on the seat which the disease occu- 
pies; thus we often see it dry on the back, crusty or fari- 
naceous on the chin, red and inflammatory on the cheeks, 
&c. &c. All the inflammations of the skin may assume 
the herpetic form, while the herpetic disease may like- 
wise transform itself into any inflammation whatever, 
whether internal or external. 

Since it has been shown that herpes is a cutaneous in- 
flammation, or sub-inflammation, it follows that it may be 
produced by all the stimulating or irritating agents which 
act upon the skin, and which are capable of producing 
other kinds of inflammation. We must only recognise a 
predisposition, or to speak more correctly, a peculiar irri- 
tability which disposes to this form rather than to another. 
We regard as being peculiarly in this state of predisposi- 
tion, persons of light complexion, who have a delicate 
skin, those of a lymphatic, scrofulous, scorbutic, or phthi- 
sical constitution. The occasional causes then are the ap- 
plications of irritants to the skin, insolation, want of clean- 
liness, dampness, the employment of blisters, and of issues, 
the frequent occurrence of boils and erysipelas, certain in- 
gesta which irritate the alimentary canal, the irritations of 
which repeat themselves more or less readily on the skin, 
according to the constitution of the individual; moral af- 
fections of great intensity likewise occasion this disease, 
as numerous examples demonstrate; the suppression of a 
periodical haemorrhage, or other evacuation, as of an issue, 
and violent exercise also give rise to it. Herpes may 
22 



!66 THE PHYSIOLOGICAL 

succeed to variola, to rubeola, to scarlatina, in one word, 
to all the irritations of the skin. 

The reappearance of herpes at certain periods is ex- 
plained by the disposition which the skin, like most other 
organs contracts, to receive anew the irritation, with which 
it has been once attacked, the determining causes remain- 
ing the same, and a fortiori, when the influence of these 
causes is increased, as happens in certain seasons. 

Prognosis. 
As a general proposition, we may assert, that herpes is 
easily cured in infants, obstinate in adults, and almost in- 
curable in old persons. It is more stubborn in women 
than in men, when it coincides with the final suppres- 
sion of the menses. In lymphatic constitutions, disor- 
ganization occurs more readily, and herpes is more rebel- 
lious; then follow bilious individuals whose very irritable 
gastric system contributes to keep up the cutaneous irri- 
tation; finally, persons of a sanguine constitution are most 
readily cured. We should not give these propositions 
too comprehensive a sense, for the duration of the inflam- 
mation, its degree of intensity, the extent and depth of 
the tissue which it implicates, render the cure more or 
less difficult, and often impossible. When herpes suc- 
ceeds a protracted internal malady of the chest, or lower 
belly, the prognosis is unfavourable, and if it be cured, 
the internal disease may reappear. When this disease ex- 
ercises no influence over the viscera, the prospect of cure 
is favourable; if there is continual fever, and it has con- 
nection with the irritation of the skin and the viscera, the 
prognosis is unfavourable. 

Treatment. 
It differs according as the complaint is light and attend- 
ed with little inflammation, or obstinate, and accompanied 



PRACTICE OF MEDICINE. 167 

with violent inflammation. Thus, in recent furfuraceous 
herpes, it is generally sufficient to use the warm bath, to 
provoke some revulsive evacuations, if the constitution 
permit the measure and the digestive tube be sound, and to 
administer mild sudorific drinks. If the disease do not 
yield to these means, frictions with the sulphur ointment, or 
the use of the hydro-sulphurous baths, will dissipate it. If 
the herpes be red and painful, we must calm the irritation 
by emollient applications, in fomentations ancl cataplasms, 
such as the decoctions of mallows, barley, or dog-grass; the 
gummy solutions; milk; oleaginous frictions; by warm 
baths, simple or gelatinous; a light and vegetable diet; by 
local bleeding around the seat of the disease, and even by 
general blood-letting. If we observe a relation between the 
herpes and an habitual evacuation, we must re-establish the 
evacuation, and calm gastric irritation, if it exists, by 
emollients. If herpes be critical of an internal irritation, 
it is not prudent to make it disappear promptly, even if 
that were practicable, for, in suppressing the vicious ac- 
tion of the skin, we may cause that of the interior to re- 
appear, unless we establish an artificial irritation by 
means of an issue. 

All these precautions being taken to calm the irritation 
as well internal as external, we place the patient under a 
regimen calculated to allay irritation, proportioning it to 
his strength; we prescribe the prolonged use of white 
meats, fresh vegetables, cooked fruits, milk. We banish 
salt provisions, ragouts, rich food, and spirituous liquors, 
not because they produce acrimony of the fluids, but be- 
cause they irritate the digestive organs. The disease will 
often yield to these means alone. If they persist, we shall 
have recourse to the most appropriate revulsives. Inter- 
nally, these are mild purgatives, which are suitable for 
persons of a good constitution, and whose digestive or- 
gans are perfectly sound; afterwards sudorifics may be 



168 THE PHYSIOLOGICAL 

used. But they do not suit persons who are nervous and 
irritable, weak, delicate, and habitually constipated. We 
should suspend their use whenever they occasion gastric 
symptoms. The sudorific drinks most used are the 
ptisans made of elm, wild violet, fumitory, rumex pati- 
entia, scabiosa, menyanthes, solanum dulcamara. Persons 
whose nervous system is very irritable, should confine 
themselves exclusively to a diet of the feculent sub- 
stances, of milk, to aqueous drinks, to gelatinous broths, 
to the juice of fresh plants; they should likewise make 
use of the warm bath. 

The external revulsives are, in the first place, the pre- 
parations of sulphur, such as ointments of sulphur, hydro- 
sulphurous lotions, the natural, or artificial hydro-sulphu- 
rous baths, douches of the same nature, and emollient or 
sulphurous vapours. We likewise employ mercurial 
ointments, that of iodine, the citron ointment, decoctions 
of the narcotic plants, metallic and vegetable astringents, 
such as the sulphate of zinc, the acetate of lead and of alu- 
mine. The substances containing tannin may be employ- 
ed with success when the herpes is not of the phagedenic 
character, and when there is neither fever nor internal 
irritation. The medicinal prussic acid in the proportion 
of a drachm for six ounces of distilled water or alcohol, 
used as a lotion, produces sometimes, a very prompt cure. 
In certain cases the cauterization of the pimples with 
nitrate of silver, muriatic acid, or any other caustic is 
practised with success; in other cases the inflammation is 
covered with a large blister to destroy it entirely, by re- 
moving the epidermis, but this mode may cure or double 
the disease. If the inflammation becomes exasperated 
under these diverse topics, we replace them with sooth- 
ing applications, to resume them at a later period. 

The phagedenic herpes should be treated at first with 
local bleedings and emollients, to calm the irritation; we 



PRACTICE OP MEDICINE. 169 

then extirpate the ulcer with the bistoury, with the hot 
iron, the nitrate of silver, the muriate of antimony, &c. It 
is essential to allay the irritation before using these means; 
without this precaution the ulcer might become extremely 
obstinate, and assume the cancerous character. 



This affection is in relation to the scalp, what herpes is 
to the rest of the body. There is no essential difference 
between them. In fact, tinea is a pustular inflammation, 
the vesicles of which permit a matter to escape, and leave 
an ulceration, which covers itself with crusts of different 
forms. 

Symptoms. 
We see upon the hairy scalp crusts, more or less close to 
each other, sometimes confluent, grouped in patches, or ex- 
tended uniformly over the whole head. These crusts assume 
different forms, to which authors have given different names. 
Thus they call it Tinea favosa, when the crusts resemble 
a honey-comb; Tinea granulata, when they are promi- 
nent in the form of grains; Tinea mucosa, when they 
permit a thick fetid matter to ooze out, which glues the 
hair together; Tinea porriginosa, or furfur -acea, when 
they detach themselves in the form of scales of bran; 
Tinea amiantacea, when the crusts assume the form of 
stalactites, of amianthus, &c. None of these differences 
arc essential, they depend only on the abundance, more 
or less considerable, of the humour secreted, and its dis- 

i position to concrete under different forms. Our attention 
is to be given only to the intensity of the irritation and 
its extent. If the scalp is hot and red, and there is great 
exudation, the tinea is inflammatory; if the crusts be 
thinly scattered and furfuraceous, there is little irritation; 
this is the case also when the crusts are very isolated. 



170 THE PHYSIOLOGICAL 

Causes. 

This affection is not contagious, but the disposition to 
contract it may be hereditary. Although no age or con- 
stitution is exempt from it, yet it selects in preference 
children and youth, and the lymphatic and scrofulous. 

It is contemporary, sometimes, with engorgement of 
the lymphatic glands, and with chronic inflammation of 
the eyelids. Herpes and tinea sometimes supplant each 
other alternately. The occasional causes among persons 
predisposed, are want of cleanliness of the head, lice, at- 
mospheric vicissitudes, bad nourishment, and perhaps an 
affection of the alimentary canal. 

Prognosis. 
It may remain stationary for a long time without any 
perceptible influence on the internal parts, but if it be ex- 
asperated by the treatment, it may become very intense, 
give rise to collections of matter in the scalp, to engorge- 
ment of the lymphatic glands, to fever, and even to cere- 
bral inflammation, and thus prove fatal. It may disappear 
by the development of an internal inflammation, some- 
times it occasions cancer, phthisis, and other serious mala- 
dies. It does not readily disappear without medical 
treatment. 

Treatment. 
To shave the head, and afterwards, if there be intense 
inflammation, to apply emollient cataplasms upon the 
scalp, and prescribe a mild and vegetable regimen. The 
application of leeches around the parts affected may be 
very beneficial. After having subdued the inflammation 
by these means, more or less frequently repeated, we em- 
ploy stimulating topics, to destroy the diseased action. 
These are of various kinds; but those which are most re- 



PRACTICE OF MEDICINE. 171 

lied upon, are hydro-sulphurous or mercurial lotions, the 
ointments of sulphur, those of pulverised charcoal, alone 
or mixed with sulphur. Lotions and ointments of iodine, 
and iodide of mercury, may prove very useful. Should 
not the employment of the chlorides be tried? The de- 
coction of the narcotic and aromatic plants are also recom- 
mended, such as the poppy, morel, hemlock, lavender, 
wild thyme, &c; likewise the metallic astringents, as the 
acetate of lead, the sulphate of zinc, alumine. If metas- 
tasis is apprehended, we have recourse to artificial drains, 
such as setons, issues on the back of the neck, blisters. 
If the ulcers become inflamed, we treat them with emol- 
lients, leeches, and abstinence. If the alimentary canal 
be sound, the diet should be analeptic without being sti- 
mulating. 

TRICOMA, OR PLICA POLONICA. 

Tli is affection is characterized by an inextricable inter- 
lacement of the hair, ordinarily accompanied with great 
sensibility of the scalp, resulting from an irritation of the 
bulbs of the hair; it is very common in Poland. 

Causes. 
Want of cleanliness; in facj this disease never occurs, 
except among the poorer classes, who wear their hair 
long, entangled under a hot cap, and who never use the 
comb, as we see among the peasants of Poland, and other 
countries. 

Treatment. 
The treatment must not be commenced by shaving the 
head, for as plica is generally accompanied with an oozing 
of matter which has become habitual, the sudden sup- 
pression of this kind of issue might give rise to irritations. 



172 THE PHYSIOLOGIC: AT. 

such as rheumatic pains, internal inflammations, inflam- 
mation of the scalp, as experience shows. We should 
therefore commence by removing the irritation by emol- 
lient and oily fomentations, by the application of a blis- 
ter to the back of the neck, or to the arm. When the irri- 
tation is calmed, we may cut the hair without inconve- 
nience. The complications which may exist must be com- 
bated by suitable means. 

LEPRA. 

The skin may be affected in conjunction with the sub- 
cutaneous cellular tissue: this is what occurs in lepra. In 
this affection the skin is thickened, deformed with eschars', 
which crack, and are rough, pruriginous, dry, or humid. 

Many divisions of the disease have been made, but an 
attentive examination would tend to establish the opinion, 
that this extraordinary deformity of the teguments may 
be referred to two modes of commencement. Sometimes 
it commences with the skin, and then it has a great ana- 
logy with herpes; at other times it commences with in- 
flammation of the subcutaneous cellular tissue, and parti- 
cularly of the lymphatic system: the first variety may be 
referred to that named the Lepra, or Elephantiasis of the 
Greek; the second to the L»epra, or Elephantiasis of the 
Arabians. 

Symptoms. 
Lepra, or Elephantiasis of the Greeks. — The skin 
covers itself with spots, which degenerate into white, 
cracked, rough, and hard crusts; passing successively into 
a state of ulceration, which alters and disorganizes the 
skin in a diversity of ways, according to the seat and in- 
tensity of the disease. If the face be affected, the features 
become deformed, enlarge, and give it the appearance of a 



PRACTICE OF MEDICINE. 173 

lion's face; hence the name of leontiasis. If the inferior 
extremities are affected, the foot and leg swell, and become 
wrinkled in a horrible manner, so that the parts resemble 
the foot of an elephant, whence the name elephantiasis. 
There is then almost complete insensibility of the skin; 
it often occasions the falling off of the feet, the hands, and 
the fingers. When the irritation is intense, and when it 
occasions an abundant afflux of the fluids, it is called red 
or scorbutic lepra. If the crusts become white, dry, and 
insensible, it is called white lepra. It is called variegated 
lepra, (lepre panachee,) when the crusts are white and 
red. It is easy to see that these varieties are not essen- 
tial. 

Lepra, or Elephantiasis of the Jlrabs. — It may attack 
different parts of the body, but as the inferior extremities are 
generally the part affected, we take this case for our model. 
Pain in the groin, swelling in this region, and an elevated 
line, resembling a cord, following the course of the lym- 
phatics. The limb is~painful and swelled, and motion al- 
most impossible. There is at the same time fever, lassi- 
tude, disgust, nausea, in one word, all the symptoms of 
an irritation of the alimentary canal. This disease ceases, 
and renews its attacks repeatedly, but the limb remains 
always swelled, and at last, at the end of two or three 
years, it suffers from the same deformities as in elephan- 
tiasis of the Greeks. Still the skin is not at first affected, 
but when the disease has continued for a long time, it is 
covered with vesicles, which are afterwards converted 
into rugous eschars. This affection has much analogy with 
certain inflammatory swellings of women in child-bed, 
and with the induration of the cellular tissue of new-born 
infants. 

Causes. 
The predisposing causes seem to be hereditary, and in- 
23 



174 THE PHYSIOLOGICAL 

herent in certain climates. The first variety is generally 
found in Egypt, in the Isle of Java, in certain provinces 
of Sweden, and the second is met with in some parts of 
Asia and Africa, and particularly under the torrid zone. 
The occasional causes are want of cleanliness, bad nourish- 
ment, probably the use of fish, and the influence of cli- 
mate. By some, the leprosy of the Greeks is regarded 
as contagious. 

Prognosis. 
When this affection is of long standing, it is very diffi- 
cult to cure. If there is but little irritation, patients may 
live for a long period suffering only from the deformity; 
but if there be much irritation, the disease is reflected on 
the viscera, and occasions death. 

Treatment. 
We must act with energy at the commencement to pre- 
vent disorganization. We employ then local, and even 
general bleeding, with boldness, and repeat it without 
hesitation, if the case requires it. When the inflammation 
is allayed, if the disease does not yield, astringent appli- 
cations are employed with success, such as the solution of 
the acetate of lead, and the compressive bandage in the 
lepra of the Arabians. In that of the Greeks, after having 
exhausted all the resources of the antiphlogistic treatment, 
we may resort to stimulating applications, at first to the 
warm bath, afterwards to the hydro-sulphurous baths, to 
the ointments of sulphur, mercury, and iodine, as in herpes, 
and perhaps to the chlorides. If the inflammation returns, 
we suspend the employment of these medications, to re- 
sume the antiphlogistic treatment. In the cases compli- 
cated with internal phlegmasia?, we treat the complica- 
tions by the ordinary means. 



PRACTICE OF MEDICINE. 175 



INDURATION OP THE SKIN IN NEW-BORN INFANTS. 

New-born infants sometimes suffer from an affection 
which seems to have some relation to those which have 
been described. The skin and subcutaneous cellular tis- 
sue become hardened in a remarkable manner. This dis- 
ease commences sometimes with an erysipelas, but most 
frequently without it. The limbs become swelled, hot, 
and painful to the touch; the infants cry, and suffer from 
embarrassed respiration, and die. 

Treatment. 
The idea of a specific property has caused baths of 
sage to be recommended in this disease, but this substance 
has no specific property. If the infant is strong, three or 
four leeches are to be applied; he is to be put into a warm 
bath, and emollient fomentations are to be employed. If 
the child be cold and weak, we abstain from bleeding, and 
confine ourselves to warm baths, rendered stimulating by 
the decoction of sage, or any other aromatic plant. 

ARTHRITIC AND MUSCULAR PHLEGMASIA. 

The fibrous system composing the apparatus of locomo- 
tion, comprehends the muscles, their aponeurosis, and 
their tendons, the ligaments, the synovial capsules, and 
the periosteum. These tissues, the most of which are in- 
sensible in their normal state, acquire an excessive sensi- 
bility in the morbid condition, and when one of the tis- 
sues is inflamed, the others often suffer at the same time, 
or rather the irritation transmits itself from one to the 
other with the greatest facility. This inflammation may 
likewise assail the neighbouring parts, as the cellular tis- 
sue, and give rise to phlegmon, and to abscess. It may 



17fi THE PKVSTOT,ORTf:AT. 

repeat itself upon the viscera, either by abandoning its 
primitive seat, and then it is a real metastasis, or without 
leaving the part originally affected; most of the external 
phlegmasia?, cutaneous or otherwise, act in the same man- 
ner. The idea of humours, invented for the sake of ex- 
plaining the sudden transfer of pain from one part to 
another, are altogether chimerical. 

The common theory of irritation is sufficient to account 
for these phenomena. 

Different names have been given to the affection of these 
tissues, according as the pain occupies one or more articu- 
lations, the synovial membranes, or the fibrous muscular 
tissues, according as it is acute or chronic, with or with- 
out tumefaction, fixed or wandering: such are the names 
of gout, of rheumatism, of gouty rheumatism, &c. The 
slightest attention will show that these denominations are 
faulty, because they do not express the nature of the ma- 
lady. The name of arthritis, and of muscular inflamma- 
tion, or myositis, are much more proper. 

Arthritis is acute or chronic, confined to one articula- 
tion, (monoarthritis,) or involving several, (poluarthritis.) 
The same is the case with muscular inflammation. From 
the most acute to the most chronic forms, there are a great 
number of shades; but we must beware of taking them for 
essential maladies, or diseases sui generis. 

These two orders of phlegmasia? sometimes exist at the 
same time, or change themselves into each other. The 
causes of articular and muscular inflammations are, in the 
first place, cold, particularly if it acts when the body is 
heated. In these cases, the action of the skin is increased, 
and if the cold suspends it suddenly, it is repeated upon 
the viscera, or upon the muscles, or upon the ligaments, 
and the articular capsules, or upon all these points simul- 
taneously. Then follows, in the list of causes, irritation 
of the viscera, and particularly of the digestive organs; 



PRACTICE OF MEDICINE. 177 

thus we commonly meet with this affection among persons 
addicted to the pleasures of the table; these inflammations 
are likewise occasioned by the suppression of an habitual 
evacuation, and by the abuse of venereal pleasures. The 
alterations of the articulations, and the morbid productions 
which we sometimes find in the synovial capsules, should 
be considered as the result, and never as the cause of 
these phlegmasia?, although they may contribute to keep 
them up. 

SIMPLE ARTHRITIS, THE GOUT OR PODAGRA OF AUTHORS. 

Gout is an inflammation of the synovial capsules, and 
articular ligaments of one or more of the fingers or toes. 

Symptoms. 
The attack is sometimes sudden, but in the greater 
number of cases, it is preceded by general uneasiness, 
by disgust and dejection, in one word, with all the 
signs of an affection of the digestive organs; there is 
afterwards an explosion of pain more or less acute in the 
great toe, or more rarely in another articulation of the 
foot; this pain is accompanied with shivering, heat, and 
with fever, which goes on increasing until the following 
night. All the symptoms diminish then in intensity, or 
cease entirely, and we find the suffering part red and tumefi- 
ed. During many days the pain and fever return ordina- 
rily towards evening. The inflammation does not always 
attack the toe which had been first aUcctcd, but it assails 
sometimes that of the other foot; it then, in another at- 
tack returns to the first, or shows itself in another articu- 
lation. Finally, after having suffered more or less se- 
verely during two or three weeks, the patient finds him- 
self entirely restored. There arc some individuals who 
only experience a slight transient swelling in one or more 



178 THE PHYSIOLOGICAL 

of the joints, without any fever. The gout may confine 
itself to this first attack, but more generally it appears at 
intervals more or less remote, after the lapse of some 
months or years, and at certain seasons. 

The course of the disease is not always the same. The 
inflammation, after having been seated in the articulations, 
sometimes abandons them suddenly, and is replaced by 
that of some of the viscera, and most frequently by that 
of the stomach, whence result anxiety; nausea; vomiting; 
pains at the epigastric region; the ordinary signs of gas- 
tritis; if the heart be affected, palpitations and syncope 
occur; if the lungs, symptoms of asthma make their ap- 
pearance; if the brain be attacked, there may be cepha- 
lalgy, more or less violent, encephalitis, apoplexy, palsy, 
&c. It is in these cases that the gout is said to have re- 
troceded, and that it has been thrown upon the stomach, 
the heart, &c. These words are devoid of sense, or they 
express an absurdity. In all these instances there is a 
metastasis, and nothing more; that is to say, an inflamma- 
tion supervening in the stomach, the heart, &c. has dis- 
placed that of the articulations. It is always in accordance 
with the principle, "duobus doloribus simul obortis, sed 
non in eodem loco, major obscurat alterum." Let it suf- 
fice to have stated this theory, the limits of the work not 
permitting us to enter into a detail of the proofs which 
serve to demonstrate it. The gout offers, besides, many 
other shades, which it is useless to enumerate. In an ul- 
timate analysis of the disease, we always have an articular 
phlegmasia, acute or light, recent or ancient, with or with- 
out complication of internal phenomena. 

Causes. 
Predisposing. — A plethoric constitution, the sanguineo- 
bilious temperament, a hereditary organic predisposition. 
Occasional. — The pleasures of the table, the abuse of 



PRACTICE OF MEDICINE. 179 

spirituous drinks, venereal excess, a luxurious and seden- 
tary life, the impression of cold, humidity, the suppres- 
sion of an habitual evacuation, of an issue, of a cutaneous 
eruption. 

Prognosis. 
This affection is not dangerous while the inflammation 
confines itself to the articulations, but if there is a concomi- 
tant internal inflammation, or a metastasis, the danger is 
in proportion to the seat and intensity of this inflamma- 
tion. The chronic gout is more serious than the acute, 
because the viscera and the articulations have acquired 
the habit of irritation, and it remains fixed in them, and 
occasions, in the course of time, diverse alterations in 
them. 

Treatment. ' 

Nothing is more complicated, or more contradictory 
than the modes of treatment, pursued in all ages, in this 
affection ; this might be expected, for, in regarding this 
malady as sui generis, it was natural to seek a specific 
for it. 

The treatment most appropriate in the actual state of 
the science, consists in removing the inflammation at its 
commencement by leeches. If we have recourse boldly 
to this expedient, in the first hours of the attack, we will 
often prevent the whole series of symptoms that otherwise 
would follow. Even when the inflammation is ancient, 
and when it has already affected other articulations, we 
employ the same means, and pursue the phlegmasia by 
local bleedings, wherever it makes its appearance, for, if 
we do not dissipate it as in the first'ease, we at least render 
the attack more tolerable. The quantity of blood to be 
taken, and the number of times the leeches are to be ap- 
plied, must be in proportion to the violence, the extent, 



180 THE PHYSIOLOGICAL 

and the obstinacy of the inflammation; emollient cata- 
plasms are then to be applied, notwithstanding the swell- 
ing that may supervene. If there be symptoms of gas- 
tritis, emollient drinks, demulcent regimen, little or no 
food. When the symptoms diminish in intensity, when 
there is no fever, and when the tongue becomes pale and 
moist, we may operate a light revulsion on the intestinal 
canal, by means of some mild purgatives. If there be 
metastasis to the interior, that is to say, if the arthritic in- 
flammation is replaced by a phlegmasia of the stomach, of 
the pleura, of the lung, of the heart, of the brain, &c. the 
internal inflammation may be sufficiently intense to re- 
quire prompt and copious general and local bleeding. We 
may, at tfie same time, employ revulsives externally, to 
recall the inflammation to its primitive seat. This prac- 
tice is essential even when the internal inflammation has 
but little intensity. 

Most of the irritating or stimulating topical applica- 
tions may conduce to this object; but among the differ- 
ent revulsives, that called the plaster of Pradier, unit- 
ing the effect of a blister with that of a cataplasm, de- 
serves the preference. Its composition is as follows: 
R. Balm of Mecca - - four drachms, 
Peruvian bark - - one ounce, 

Saffron - half an ounce, 

Sarsaparilla ~) 

T . > - - aa. one ounce, 

.Leaves oi sage j 

Rectified alcohol - - three pounds. 
Dissolve the balm in a third of the alcohol, and macerate 
the other substances for twenty-four hours in the remain- 
ing two-thirds; strain, and mix the liquors; to this mix- 
ture add six or seven pounds of lime water and preserve 
it in well-corked bottles. 

To make use of it, we pour some drops upon a flaxseed 
cataplasm, which we apply as hot as possible upon the af- 



PRACTICE OP MEDICINE. 181 

fected part, and renew it twice a day. Sinapisms may be 
substituted for this preparation. Revulsives should not be 
employed in simple gout which makes its appearance for 
the first time, except when the inflammation has fallen or 
has a great tendency to fall upon the viscera. In this case, 
no sudoriflcs or other internal stimulants which might ex- 
asperate the inflammation, should be used. 

We prevent a return of the attacks by an avoidance of 
the occasional causes, by a perseverance in a mild and 
moderate diet} if the patient has been accustomed to high 
living, he must renounce it forever. 

For some time, the use of iodine internally as well as 
externally, has been recommended in gout, and many ex- 
amples are cited of solid cures obtained by this medicine. 
The good effects of this substance in chronic engorgement 
of the glands is well known, and it would appear from the 
trials that have been made, that it acts in a similar man- 
ner upon the white tissues of the articulations. Whatever 
may be the fact, iodine should never be given internally, 
when the digestive organs have a tendency to inflam- 
mation. 

ARTHRITIS OCCUPYING THE GREAT ARTICULATIONS, OR 
RHEUMATIC GOUT. 

This affection differs from the latter only in this, that 
instead of attacking the small articulations, it attacks the 
great, or it assails both classes, either simultaneously or in 
succession. 

Symptoms. 

Heat, swelling, acute pain in one or more articulations, 

augmented by pressure, or by twisting and motion, accord- 

ingasthc inflammation is confined to the ligamentous tissues 

and to the synovial capsules, or extends to the neighbour- 

24 



182 THE PHYSIOLOGICAL 

ing cutaneous and cellular tissues. The pain is sometimes 
so acute that the limb cannot endure the slightest motion 
without the suffering becoming horrible. This phlegmasia 
developes many sympathetic phenomena, and principally 
irritation of the digestive organs, fever, lassitude, clammy 
mouth, anorexia, thirst, sleeplessness; ordinarily there is 
exacerbation in the evening. After having persisted for 
twenty-four or thirty-six hours in an articulation, there is 
a diminution of all the local and sympathetic symptoms. 
Some hours after this the phenomena of inflammation are 
renewed, sometimes in the same articulation, but most 
frequently in another. Inflammation then abandons this 
new seat to reproduce itself in a third, and it may thus 
travel over the greater part of the articulations, from the 
smallest to those of the pelvic basin, the vertebrae, the 
ribs, &c. Sometimes it invades three or four and even a 
greater number simultaneously. This inflammation may 
extend itself to the contiguous muscles, and then there is 
a complication of arthritic and muscular inflammation; 
like the gout it abandons its primitive seat to fix itself 
upon the viscera. 

Causes. 
The same as those of arthritis, called gout, and more 
particularly cold, dampness, atmospherical vicissitudes, 
for it is seldom that persons exposed often and for a long 
time to the action of these causes, do not at last contract 
an articular phlegmasia. 

Prognosis. 
This affection lasts from five or six days to two months; 
its termination, which is ordinarily fortunate, is announc- 
ed by an abundant perspiration, or by a diarrhoea, a hae- 
morrhage, or a cutaneous eruption. When inflammation 
remains long fixed upon a great articulation, there may 









PRACTICE OF MEDICINE. 183 

result what is denominated a white tumour, or a purulent 
collection, or caries of the bone, &c. When there is me- 
tastasis to the interior, the danger results from the inten- 
sity of the inflammation, and the importance of the viscus 
upon which it has fallen. 

Treatment. 
Nearly the same as that of gout. In the acute stage, 
abundant local bleeding frequently repeated,- emollient fo- 
mentations; demulcent drinks; absolute abstinence if the 
fever is brisk; a light and mild diet, if the gastric symp- 
toms are not very prominent. In the chronic state, after 
the employment of the same means as those enumerated, 
revulsives, such as the moxa, a blister, the plaster of Pra- 
dier, aromatic fomentations and fumigations, douches, 
electricity, the covering of the affected parts with wool, 
mild purgatives, drinks slightly sudorific. If the diges- 
tive organs are in good condition, the use of iodine in 
frictions is to be tried, with a mild and limited diet. If 
the inflammation returns to the acute state, this treatment 
must give way to the employment of antiphlogistics. If 
there is recession of the disease, or metastasis to one of 
the viscera, emollients must be employed internally, and 
revulsives externally, to bring back the irritation to its 
primitive scat. Some practitioners recommend the em- 
ployment of tartar emetic in divided doses, in acute rheu- 
matic gout, and experience appears to confirm the utility 
of this practice, provided the intestinal canal be exempt 
from all irritation. The dose is four or five grains in 
twenty-four hours. 

MUSCULAR INFLAMMATION, MYOSITIS, RHEUMATISM. 

The inflammation of the muscular, tendinous, and apo- 
neurotic tissues, constitutes the rheumatism, properly so 



184 THE PHYSIOLOGICAL 

called, of authors. These phlegmasia are either simple, 
that is, confined to the tissues designated, or they are com- 
plicated with inflammation of the neighbouring articula- 
tions; thelatteristherheumaticgoutdescribedabove. Some- 
times, and principally in the acute state, the inflammation 
assails the cellular tissue interposed between the muscles 
and the aponeuroses, and there results promptly a phleg- 
monous state. Rheumatism is acute or chronic. 

Symptoms. 

Acute Rheumatism. — Fever, acute rending pain along 
the course of the muscles, fixed or moveable, assailing 
sometimes the great articulations, augmented by pressure, 
and often even by the slightest touch, but especially by 
motion. High-coloured urine, constipation, exacerbation 
towards the evening. 

The nature of muscular inflammation is always identi- 
cal, yet authors give it different names, according to the 
seat which it occupies; thus it is called muscular sciatic 
rheumatism, when it has its seat in the posterior and late- 
ral and even anterior muscles of the thigh, and in the 
coxo-femoral articulation. We distinguish this inflamma- 
tion from the sciatic inflammation by the circumstance, that 
in the latter, pressure does not augment pain, and that it is 
not attended by swelling, which occurs in muscular sciatic 
rheumatism, particularly in the acute stage. It has been 
called lumbago, when it occupies the muscles of the lum- 
bar region; diaphragmitis or paraphrenesis, when it is 
seated in the muscular fibres of the diaphragm. There 
occurs then very difficult respiration, with pain in the re- 
gion of the diaphragm, vomiting, dry cough, delirium, 
risus sardonicus. The inflammation of the muscles of 
respiration, and particularly of the intercostals, is impro- 
perly called pleurodynia, for the pain is not in the pleura, 
but in the muscles. We easily distinguish this affection 



PRACTICE OF MEDICINE. 1S5 

from that of the pleura or thoracic viscera, by the cir- 
cumstance, that in the muscular inflammation, the pain is 
rendered more sensible by pressure, which is not the case 
in the other affections. These two affections, however, 
may coincide. Rheumatism takes the name of torticollis 
when it affects the lateral or posterior muscles of the cer- 
vical region, an affection which renders the motions of 
the neck, particularly those of rotation, very painful, and 
sometimes impossible. The rheumatism of the muscles 
which are about the cranium, has received no particular 
name, for gravedo signifies nothing. We recognise it by 
an external pain of the head, augmented by pressure, or- 
dinarily without the concomitance of febrile phenomena. 

These diverse phlegmasia^ are displaced with the great- 
est facility, most frequently to be transferred to other 
fibrous tissues, but sometimes also they abandon the ex- 
ternal parts, to fix themselves upon the viscera. 

Chronic Rheumatism. — It sometimes succeeds acute 
rheumatism, and in that case the commemorative symp- 
toms enable us to distinguish it readily. When it is pri- 
mitive, there is a dull pain, augmented by pressure, by 
motion, the heat of the bed, by atmospheric vicissitudes, 
with a sensation of cold and numbness in the part affected. 
Although more fixed than in the acute state, the pain may 
transport itself from one point to another. The functions 
of the intestinal canal are often deranged, especially when 
there is an exacerbation. The chronic disease may be- 
come acute, and then the symptoms are the same as those 
already described. It may also be superseded by a vis- 
ceral phlegmasia, not because the rheumatism has gone 
in, as they say, but because "duobus doloribus simul 
obortis, sed qoq in eodem loco, major obscurat altcrum." 
Between the very chronic and very acute state, there is 
yet an infinity of shades easily recognised, upon which it 
is unnecessary to insist. 



186 THE PHYSIOLOGICAL 

Causes. 
The same as those of arthritis, particularly of the spe- 
cies called gouty rheumatism. 

Prognosis. 
The duration of acute rheumatism, like that of the 
gouty rheumatism, is from six to fifty or sixty days. It 
may terminate, by a profuse perspiration, by a looseness, 
by a cutaneous eruption, &c. If the inflammation be very 
acute, and be situated in the muscles surrounded by cel- 
lular tissue, it may give rise to phlegmon, that is, to in- 
flammation of this tissue, or to purulent collections more 
or less extensive, the absorption of which may occasion 
hectic fever and death. When there is metastasis to one 
of the viscera, the danger is in proportion to the intensity 
of the inflammation, and the importance of the part at- 
tacked. The duration of chronic rheumatism is indefinite; 
it is liable to relapses, particularly under the influence of 
atmospheric vicissitudes. 

Treatment. 

The *B.cute state. — This phlegmasia must be combated 
boldly by the antiphlogistic treatment, topical, and even 
general blood-letting, abundant and often repeated, to 
meet the exigency of the case, and to prevent suppura- 
tion. If suppuration occurs, we must make an outlet for 
it with the bistoury, to prevent subsequent disorders. If 
the digestive apparatus is sound, we may try the tartar 
emetic as in rheumatic gout. 

Chronic state. — The same treatment as in chronic ar- 
thritis and rheumatic gout. Woollen garments worn next 
the skin, revulsives externally, dry vapours, douches of 
the same nature, baths of the thermal or sulphurous wa- 
ters, aromatic fumigations. Some mild purgatives, if the 



FRACTICE OF MEDICINE. 187 

state of the alimentary canal permits their employment, a 
mild, unirritating regimen, the avoidance of cold and 
moist air. The effects of acupuncturation are highly ex- 
tolled. 



HEMORRHAGES, OR IRRITATIONS WITH A FLOW OF BLOOD. 

Haemorrhages have the greatest relation to inflamma- 
tion. In both, there is first irritation, then sanguineous 
congestion, but in inflammation the blood remains in the 
part, whereas in haemorrhage it escapes from the vessels. 
The precursory phenomena of haemorrhage are the same 
as those of inflammation, and it supervenes under the in- 
fluence of the same causes. If the congestion be not one 
of too great violence, and the blood find a ready outlet, 
as the flow of blood proceeds, the circulation loses its ac- 
tivity, the sense of weight which had existed previously, 
dissipates itself by degrees, and the equilibrium is re- 
stored. 

It follows from this, that we should often consider hae- 
morrhage as a bountiful interposition of nature, its effect 
being to dissipate irritation. 

In inflammation, we imitate this example of nature, 
when we have recourse to local and general bleeding to 
remove sanguineous congestion, and to break up the inflam- 
mation promptly. This happy result, however, can only 
be obtained by acting seasonably, and carrying the blood- 
letting to a sufficient extent. 

The same is the case in haemorrhage. This discharge, 
in fact, does not always destroy the irritation, for, if it is 
not proportioned to the congestion, or if it be arrested 
unseasonably, we often see it succeeded by inflammation, 
exactly as inflammation perseveres, or even augments, 
when the local bleeding is not proportioned to its extent 
or intensity. 



1S8 THE PHYSIOLOGICAL 

We must then in general avoid interfering with the 
haemorrhage, when the blood finds its way readily to the 
exterior of the body; but if the loss of blood be sufficient- 
ly abundant to endanger the patient, we should arrest it 
even at the risk of augmenting the irritation. 

If the haemorrhage occur in the interior of the body, 
and does not find an issue, the indication is to calm the 
irritation, or to replace it by revulsives, or to remove it 
by practising blood-letting. In some cases the extrava- 
sation requires in addition some particular attentions. 
There is then a perfect identity in haemorrhage and in- 
flammatory irritation; the causes and treatment are the 
same; sometimes their existence is simultaneous; some- 
times they succeed one another either in the same or in 
different parts. 

But how do the same causes produce at one time hae- 
morrhage, at another time inflammation? This difference 
depends on the individual predisposition, upon the tex- 
ture more or less compact of the tissues irritated, and par- 
ticularly upon the quantity more or less considerable, of 
sanguineous vessels with which they are furnished. This 
explains the frequency of haemorrhage in mucous mem- 
branes, in the lungs, and in the brain, and likewise ac- 
counts for their occurring seldom in the serous tissues, 
and the impossibility of such accidents in the fibrous, os- 
seous, and cartilaginous tissues. 

It has been remarked also that persons predisposed to 
haemorrhage have in general their hearts large and active, 
yet, although the energy of the heart contributes to haemor- 
rhage, it may be occasioned by local irritation alone. The 
extravasation of blood in one of the viscera, or internal 
haemorrhagy, is owing to the irritation of the organ, 
in consequence of which the blood is drawn to it, in 
quantities so great as to force its way out at the extremi- 
ties of the vessels, or even to break them. It is thus that 



PRACTICE OP MEDICINE. 189 

apoplexy of the brain and lungs occurs, and even some- 
times an extravasation of blood into the cavity of the pe- 
ritonaeum. These affluxes may prove promptly mortal; 
when they are not so, we treat them as inflammations. 

Every spontaneous haemorrhage is, like inflammation, 
active; it is the product of a vital exaltation of the tissues, 
and not of their relaxation or flaccidity. There are no 
passive haemorrhages, except those we call traumatic, or 
those which depend on obstacles to the blood, such as a 
ligature, a polypus, an aneurism, a varix, &c. 

The partizans of passive haemorrhage advance, as sup- 
porting their hypothesis; first, the extreme weakness of 
certain persons who are yet very subject to haemorrhage; 
secondly, the absence of the precursory symptoms, which 
they call molimen naturae; thirdly, cures obtained by to- 
nics, and particularly by astringents. 

These objections are only specious, for first, the weak- 
ness of the subject proves no more in favour of passive 
haemorrhage than in favour of passive inflammation, and 
in a weak subject, local irritation with consecutive hae- 
morrhage may readily occur; secondly, the absence of the 
molimen naturae, only proves that haemorrhage may take 
place without an excitement of the whole system; local 
irritation is sufficient to occasion an afflux of blood; thirdly, 
real cures have been obtained from the use of astringents; 
these are coercive means, which may arrest the flow, but 
which may likewise augment it, if their action is not su- 
perior to the reaction which they provoke. A solution of 
alum, of acetate of lead, of tannin, &c. may suppress cu- 
taneous transpiration, the application of ice may dissipate 
a phlegmasia, or an astringent collyrium destroy an in- 
flammation of the conjunctiva. Shall we on this account 
say that cutaneous transpiration, phlegmon, and ophthal- 
mia are passive? By no means. These applications suc- 
ceed in light irritations and inflammations, which are 
25 



1.90 THE PHYSIOLOGICAL 

made by them to retrocede, if the expression may be 
used; if they succeed oftener in haemorrhages than in in- 
flammations, it is because the flow of blood has extinguish- 
ed a great part of the irritation before they are applied, 
and because haemorrhage being often but a slighter degree 
of inflammation, reaction is less to be feared. 

NASAL HEMORRHAGE, OR EPISTAXIS. 

Symptoms. 

A flow of blood more or less abundant by the nostrils, 
often preceded by pain, and weight of the head, by red- 
ness of the face, vertigo, dimness of sight, itching of the 
nasal fossae. 

Causes. 
Predisposing. — Infancy and youth, on account of the 
predominance of vital energy in the superior parts of the 
body; the sanguine temperament; high living, Epistaxis 
is often connected with a cerebral or gastric irritation, and 
sometimes with a hypertrophy of the heart; it may be de- 
termined by insolation, by the cravat, or other parts of 
the dress being too tight, by the suppression of an habi- 
tual haemorrhage, by irritants introduced into the nostrils^ 
by blows or falls upon the head, &c. 

Prognosis. 
It is moderate; it is rarely a dangerous affection, par- 
ticularly in persons naturally of a robust constitution. It 
is often critical of another disease, among others of a ce- 
phalalgy, of an encephalitis, of a cerebral apoplexy. In 
low fevers, called adynamic, or malignant, the emission 
of a few drops of blood by the nostrils, is regarded as a 
bad omen, because it indicates a violent inflammation of 
the brain. 






PRACTICE OP MEDICINE. 191 

Treatment. 

When haemorrhage is moderate, or critical of another 
affection, we should beware of arresting it too promptly; 
if it depends on an irritation of another organ, we combat 
this irritation by appropriate means; if it is very abundant 
we expose the patient to the cold air. Cold, or iced 
lotions or compresses upon the forehead or around the 
nose; we prescribe also, as revulsives, aspersions of cold, 
or iced water upon the sexual organs; ligature of the 
limbs; hot and mustard pediluvia and maniluvia; and 
finally, when all other means have failed, the plugging of 
the nasal fossae. 

If epistaxis is vicarious to another haemorrhage, the 
latter must be recalled to its primitive seat. 

The prudent employment of digitalis is to be tried, if 
there be a tendency to hypertrophy of the heart, on con- 
dition always, that the stomach be not the seat of any 
irritation. 

-CEREBRAL APOPLEXY, OR HAEMORRHAGE OP THE BRAfN. 

Dissection proves, that cerebral apoplexy is produced 
by an extravasation of blood : it should therefore be 
classed among the lucmorrhagies. 

Symptoms. 
An abolition more or less complete of nearly all the 
voluntary movements, and of the mental faculties; a co- 
matose stale, or somnolence more or less profound; ster- 
torous respiration; redness of the face; there is, however, 
a continuance of the movements of the heart and arteries, 
which distinguishes this affection from every other, which 
may in sonic respects resemble it. These phenomena are 
ordinarily preceded by vertigo, by pains in the head, by 



192 THE PHYSIOLOGICAL 

epistaxis, by tinnitus aurium, by dimness of sight, by 
stupor, by distortions of the mouth, by embarrassment of 
the tongue, and the speech; at other times, the invasion 
is sudden, and the individual falls as if struck by light- 
ning. 

Apoplexy has been divided into slight or imperfect, 
when the haemorrhage being inconsiderable, the locomo- 
tive powers have not been entirely abolished; into violent, 
when there is a complete, or almost complete abolition 
of sensation and motion ; it is called foudroyante, when 
the effusion is so considerable and so prompt, as imme- 
diately to occasion death. We may readily conceive that, 
between the slightest degree of apoplexy, which might 
produce only drowsiness, and a slight debility in muscu- 
lar movements, and the highest degree of apoplexy, there 
are many intermediate degrees, which produce partial 
paralysis, partial convulsions, &c. &c. according as the 
compression, produced by the extravasated blood, is upon 
one or another hemisphere, or upon both simultaneously, 
upon the cerebellum, or the whole encephalic mass ; ac- 
cording as the extravasation takes place under or within 
the meninges, or in the cavities of the ventricles, &c. &c. 

Causes. 

Predisposing. — A particular irritability of the brain; 
middle age; a voluminous head; the sanguine tempera- 
ment; shortness of the neck; plethora; a sedentary life; in- 
tellectual labour; grief; chronic phlegmasia? of the diges- 
tive tube, but particularly chronic irritations of the brain, 
manifested by continued or periodical cephalalgia, by 
epilepsy, by mental alienation; by a disposition to sleep; 
by partial palsies; for every ancient or slow irritation of 
the brain may lead to apoplexy. 

Occasional. — An irritation of the brain, and every 
thing that can occasion the blood to flow towards it with 



PRACTICE OF MEDICINE. 193 

more or less violence, such are the suppression of an ha- 
bitual haemorrhage, of an artificial drain, the recession of 
a cutaneous eruption, the displacement of another irrita- 
tion, such as arthritis, an acute or chronic rheumatism, 
and a metastasis to the brain, and more particularly the 
action of cold, or of heat, insolation, violent exercise, 
strong passions, and particularly a fit of anger, excesses of 
the table, venery, tight cravats, the efforts of child-bear- 
ing, straining at stool, coughing, the lifting of burdens, 
the use of narcotics, in one word, all the causes of ence- 
phalitis. 

Prognosis* 

The gravity of this affection is in proportion to the ex- 
travasation of blood, indicated by the greater or less degree 
of violence in the symptoms; most frequently it terminates 
in death. Apoplexy supervening upon a chronic inflam- 
mation of the brain, is always very serious, for there ex- 
ist generally under these circumstances, deep and incura- 
ble organic changes. It rarely terminates in complete 
restoration to health ; it is subject to relapses, and these 
are always more dangerous than a first attack. When it 
does not occasion death, it is ordinarily followed by he- 
miplegia, more or less complete, by disturbance of the in- 
tellectual faculties, and by other cerebral disorders. 

Treatment. 
Curative. — Copious depletion, by means of bleeding 
from the arm, from the jugular veins, or the nasal veins, 
by means of an instrument recently invented by M. 
Cruveilhier, by arteriotomy, by leeches to the temples, 
or to the neck, by cupping, or preferably by the bdello- 
meter, for the sake of greater promptitude, or by produc- 
ing a nasal haemorrhage, by means of two or three leeches 
applied to the mucous membrane of the nostrils, in imita- 



194 THE PHYSIOLOGICAL 

tion of nature, who sometimes operates a cure by a 
spontaneous epistaxis. Cold applications to the head, si- 
napisms to the inferior extremities, or even to the hands, 
cool and fresh air, elevated position of the trunk and head, 
the removal of every kind of bandage or clothing which 
could prevent the free circulation of the blood. Diet, di- 
luent drinks, irritating glysters, frictions of the same na- 
ture upon the limbs, no sternutatories or emetics. 

Prophylactic. — Persons predisposed to apoplexy, or 
who, having already undergone attacks of it, have to 
fear a return, should avoid all the occasional causes men- 
tioned above. They should use moderate exercise, recall 
suppressed evacuations, submit to a light vegetable diet, 
containing but little nourishment; they should make use 
of aqueous drinks, avoid constipation, without however 
having recourse to violent purgatives, and produce from 
time to time, a light revulsion to the digestive tube, if it 
is in a good condition. For this purpose the use of the 
following preparation is prescribed with much success: — 
Super-tartrate of potash one ounce; tartar emetic, one 
grain: divide into two equal parts, one of which is to be 
taken each morning in a glass of sugar and water. Blood- 
letting from time to time, particularly on the approach of 
symptoms which may indicate the commencement of ce- 
rebral congestion, such as drowsiness, dimness of vision, 
vertigo, the augmentation of muscular debility, convulsive 
movements of the muscles, &c. 

HEMORRHAGE OF THE LUNGS, AND OF THE MUCOUS 
MEMBRANE OF THE AIR PASSAGES. 

(PULMONARY APOPLEXY, HiEMOrTYSIS.) 

We give in general the name of pulmonary apoplexy 
to an abundant extravasation of blood in the parenchyma 
«>f the lungs, and that of haemoptysis to haemorrhage of 



PRACTICE OF MEDICINE. 195 

the mucous membranes; but in addition to the difficulty 
which often exists of establishing this distinction, it is 
useless in a practical point of view. 

Symptoms. 

This hemorrhage is often preceded by a sensation of 
uneasiness, of gurgling, and of heat in the chest, and parti- 
cularly under the sternum, by a circumscribed redness of 
the cheeks, by dyspnoea, and by titillation in the throat. 
After these precursory symptoms, which may neverthe- 
less sometimes be wanting, there occurs an expectoration, 
more or less abundant, of blood, which is red, pure, and 
frothy. This expectoration returns at intervals, accom- 
panied by efforts of coughing, by redness or by paleness 
of the face, and coldness of the extremities. In pulmo- 
nary apoplexy the cough is more violent, and it may hap- 
pen that the extravasated blood cannot be expectorated, 
but this is rarely the case. 

The nature of the blood, which is red, not mixed with 
the food, and frothy, its expectoration accompanied with 
fits of coughing, with a particular rattling noise, which 
we hear in the cavity of the thorax by the aid of the cy- 
linder or without it, enable us readily to distinguish this 
haemorrhage from that of the stomach, the only diseaso 
with which we can confound it. 

Causes. 
The same as those of pneumonia, a particular, and some- 
times a hereditary irritability of the lungs, and of the air 
passages, organic alteration of these viscera, the suppres- 
sion pf an habitual haemorrhage, singing, declamation, 
loud cries, strong moral affections, violent exercise, hy- 
pertrophy of the heart, external violence. This malady 
is very subject to relapse; it assumes cither the acute or 
chronic form, and may return periodically. (See Acute 



196 THE PHYSIOLOGICAL 

Phlegmasia of the Pectoral Viscera, and Chronic forms 
of Irritation of the Pectoral Viscera.) 

Prognosis. 
Haemorrhage is always an unhappy symptom in sub- 
jects of a consumptive habit, as it indicates great irrita- 
bility of the organs of respiration; it is often a precursory 
sign of phthisis pulmonalis, which it always has a ten- 
dency to keep off, as haemorrhage dissipates in part, and 
for some time, the irritation or inflammation of the lungs, 
of which, consequently, it is the natural remedy. The 
prognosis is less unfavourable when, after the cessation 
of haemorrhage, there remains neither pain nor dyspnoea, 
nor cough, as in the opposite case; there is hardly any 
danger when the flow is the result of external violence, 
or of plethora. 

Treatment. 

If the haemorrhage is moderate, we are not in haste to 
arrest it, for it is often a salutary process of nature. In 
opposite cases, general blood-letting, repeated according 
to circumstances, rest, absolute silence, emollient drinks, 
cold, iced, afterwards slightly astringent, if the patient is 
already very weak, irritating pediluvia and maniluvia, or 
sinapisms to the hands and feet; in obstinate cases, a large 
blister made with ammoniacal ointment applied to the 
chest, an elevated position of the body, the free admission 
of cool air. 

To prevent relapses, all the occasional causes must be 
avoided; we combat the inflammatory tendency by a mild 
and milk diet; if haemoptysis arises from the suppression 
of an habitual haemorrhage, it must be recalled to its pri- 
mitive seat; and if we cannot succeed in this, we must 
supply its place with artificial bleedings. 

N. B. It is not strictly correct to say, that haemorrhage 



PRACTICE OP MEDICINE. 197 

may be the effect of the suppression of an habitual evacua- 
tion; on the contrary, this haemorrhage is suppressed on 
account of the blood being drawn to the lungs, and re- 
tained there by irritation; the basis of the treatment then 
is the calming of the pulmonary irritation, and the pro- 
ducing of irritation in the primitive seat of the haemor- 
rhage, to occasion an afflux of blood to it. The same re- 
mark applies to all the other haemorrhages which we name 
vicarious or supplementary. 

HEMORRHAGE OF THE STOMACH. 
(hjbmatemesis.) 

Symptoms. 

The precursory signs of haematemesis are in general 
the same as those of gastritis, as the precursory signs of 
haemoptysis are the same as those of irritation of the lungs. 
These signs are followed by a vomiting of black blood, 
pure, or mixed with the food, with the drinks, with bile,&c. 

The absence of cough and vomiting, and especially the 
absence of the gurgling and rattling in the chest, enable 
us with facility to distinguish haematemesis from hae- 
moptysis. 

Melaena is nothing but a haemorrhage of the stomach of 
the same nature as haematemesis; the colour, varying in 
depth, of the bloody matters discharged, cannot constitute 
a real difference; but melaena is much more frequently the 
effect of an organic alteration, of a cancer for example, 
than simple haematemesis. 

Causes. 
Generally all those of gastritis, and particularly chronic 
gastritis, accompanied with organic alteration of the sto- 
mach and its appendages, the suppression of an habitual 
haemorrhage, irritating, caustic, or corrosive ingesta, ple- 
2fi 



198 THE PHYSIOLOGICAL 

thora, external violence; congestions occasioned by inter- 
mittent fevers or irritations. 

Prognosis. 
Haematemesis is sometimes a means employed by nature 
to extinguish an acute inflammation of the stomach, and in this 
case the prognosis is favourable; it is dangerous if itsucceeds 
a chronic inflammation, because it ordinarily indicates an 
organic alteration. This observation is peculiarly applica- 
ble to melaena. The course of this haemorrhage is very ir- 
regular; it may occur but once, or it may reappear at in- 
tervals, and even assume the periodical form, which, how- 
ever, is a rare occurrence. 

Treatment. 

If the haemorrhage is abundant, we must not be in haste 
to arrest it; if it is violent, we should have recourse to 
cold or iced acidulated drinks, to topical depletion over 
the epigastrium, the horizontal position, absolute repose, 
hot or irritating pediluvia or maniluvia. If the patient be 
already weakened by the haemorrhage, we employ the ve- 
getable astringents, such as decoctions of rhatany, of oak 
bark, of bistort, of tormentil, of the great comfrey, cold 
applications to the stomach. 

When the haemorrhage is arrested, we should advise 
for some hours, diet, repose, emollient drinks, and after- 
wards a very light diet of milk and vegetables. Suppres- 
sed haemorrhages should be recalled to their primitive seats. 

HEMORRHAGE OP THE INTESTINAL CANAL. 
(hjementeiiesis.) 

Symptoms. 
Evacuation of blood varying in abundance and in red- 
ness, at first mixed with faecal matters, afterwards pure, 



PRACTICE OF MEDICINE. 19S 

and sometimes coagulated. This evacuation is generally 
attended by the same signs as haematemesis, with which it 
is sometimes accompanied, and from which it differs only 
in this, that the irritation or organic alteration, that pro- 
duces it, has its seat sometimes in the stomach, sometimes 
in the intestines, and sometimes in both simultaneously. 
The difference is the same as that which exists between 
gastritis, enteritis, and colitis, whether in their chronic or 
acute stages. 

Causes. 
This affection, which is moreover of rather rare occur- 
rence, may be the product of a sanguineous exaltation, oc- 
casioned by the irritated or inflamed intestinal mucous 
membrane; but in the greater number of cases it is the re- 
sult of organic alterations of the viscera, or of external 
violence. It is sufficient to say that it is often the result 
of a chronic enteritis or colitis. 

Prognosis. 
If this discharge is vicarious to another haemorrhage, in 
a subject in other respects healthy and robust, it is attend- 
ed with but little danger. The prognosis, on the contrary, 
is unfavourable, when this haemorrhage supervenes in indi- 
viduals, who for a long time have been affected with phleg- 
masice of the abdominal viscera; death may occur in the 
space of a few days or even of a few hours. Moreover, 
this haemorrhage may be more abundant than is indicated 
by the external flow, for on dissection, the intestinal ca- 
nal has sometimes been found filled with blood. This af- 
fection is subject to relapses. 

Treatment 
The same sffl that of li;nnatemcsis. Cold applications are 
to be made tu the abdomen. If there arc signs of acute in- 



200 THE PHYSIOLOGICAL 

flammation, leeches to the anus; but we should abstain 
from blood-letting if the internal and external haemorrhage 
is sufficient to compromise the safety of the patient; in 
this case, besides the external means employed, we should 
administer vegetable astringents in drink and in lavement. 

UTERINE HAEMORRHAGE. 
(metrokrhast.) 

Symptoms. 

Continual or interrupted evacuation, by the vagina, of 
liquid or coagulated blood, varying in abundance, ordina- 
rily preceded and accompanied by fever, by paleness of 
the face, by pain in the region of the loins, and in the 
abdomen, having a considerable resemblance to those of 
women in child-bed. 

All these symptoms, and some others which announce 
an irritation or congestion of the uterus, diminish insen- 
sibly, and sometimes cease entirely, as the blood flows. 
If the haemorrhage is abundant, there supervenes, as in 
all other cases of the same nature, debility, prostration of 
strength, coldness of the whole body, and syncope. 

In certain cases this haemorrhage is so abundant that it 
suddenly places the patient in the greatest danger. In 
this case there is a tremendous loss of blood; this loss may 
take place with or without an external flow, constituting in- 
ternal metrorrhagy. The loss may be equally tremen- 
dous as in the case of an external flow. Internal haemor- 
rhage of this kind cannot take place to an alarming ex- 
tent, except after delivery, on account of the small capa- 
city of the womb under all other circumstances. 

Causes. 
Menstrual uterine haemorrhage is the result of a periodi- 
cal irritation of the uterus. Far from being a disease, it 



PRACTICE OP MEDICINE. 201 

is, when kept within proper limits, a natural function, 
whose integrity is necessary to the health of the female. 
The same remark applies to that which necessarily follows 
delivery, but in both cases, the haemorrhage, if too abun- 
dant, departs from the normal condition. 

Besides those which occur at the menstrual epochs, the 
womb is more subject to haemorrhages than any other or- 
gan; they are always the results of irritation, and this ir- 
ritation produces sometimes haemorrhage, and sometimes 
inflammation. Every thing that irritates the uterus or 
other organs which react upon it, should then be regarded 
as the cause of the sanguineous afflux of which it is the 
seat. These causes are generally a particular irritability 
of the uterus, inviting a flow of blood to this organ; such 
are the abuse of spirituous drink, high living, blows, falls, 
violent efforts, moral affections, venery, abortion, laborious 
delivery, constipation, cold, and particularly that of the 
inferior extremities, organic alterations. Plethora is also 
one of the predisposing causes of metrorrhagy; yet thin 
and nervous women are at least equally exposed to it with 
the plethoric. The reason of this is, that in debilitated 
and nervous women, the uterus enjoys in general very 
great activity, which accounts for this exuberant affluence 
of blood, of which it has need to get rid. This observa- 
tion is necessary to dispel the false ideas of passive hae- 
morrhage, which the occurrence of metrorrhagy in feeble, 
languishing, and shattered constitutions might lead us to 
entertain. 

Prognosis. 

If the haemorrhage is sudden, and the loss of blood ex- 
cessively gnai, particularly if it be attended with cold 
sweats and convulsions, tin; danger is imminent. Ii may 

likewise lie. dang I when the flow of blood IS 

slow, it' it continued for a long time. When there is or- 



202 THE PHYSIOLOGICAL 

ganic alteration, such as polypus, scirrhus, cancer, &c. the 
chances of cure depend on the nature of these alterations. 

Treatment. 
If the flow of blood is moderate, we must beware of sup- 
pressing it; it is the remedy employed by nature to dissi- 
pate irritation; in thegreatest numberof cases it ceases spon- 
taneously, and the patient has need only of rest and some 
precautions which belong to the province of hygieine. If 
the haemorrhage threatens to become abundant, and the 
patient is strong and plethoric, general blood-letting: if on 
the contrary, the woman be of a debilitated constitution, 
and if nevertheless there are signs of strong uterine irrita- 
tion, the application of leeches to the hypogastric region. 
The verity of the fiftieth aphorism of Hippocrates is per- 
fectly confirmed by experience; but few women would at 
this day submit to the treatment: "mulieri menstrua si 
velis cohibere, cucurbitam quam maximam ad mammas 
appone:" we observe that a revulsion is here spoken of, 
which, although less efficacious upon other parts, should 
never be neglected in urgent cases. If haemorrhage is al- 
ready very abundant, we abstain from the further abstrac- 
tion of blood; but we try to suppress it by other means. 
The most suitable are the horizontal position, upon a bed 
rather hard than soft; exposure to cool air; cold, iced, or 
astringent drinks, such as the decoction of rhatany, of the 
bark of oak, of comfrey, bistort, and other substances con- 
taining tannin, and of tannin itself, in the dose of two or 
three grains, taken two or three times a day, &c. ; the ap- 
plication of compresses wet with liquids of the same na- 
ture to the abdomen and to the perinseum; and if the 
abundance of the haemorrhage is such as to require it to 
be arrested with great promptitude, dry cups to the abdo- 
men, and even upon the breasts; cold and astringent injec- 
tions; plugging with lint, wet with an astringent liquor, 



PRACTICE OF MEDICINE. 203 

or the introduction, as far as the neck of the womb, of a 
lemon deprived of its rind. To finish the delivery, and 
afterwards to solicit the contraction of the womb by pinch- 
ing, and exciting it through the parietes of the abdomen. 

Of late, the trials, which had been abandoned, of the 
transfusion of blood in women, who would otherwise be 
condemned to inevitable death from excessive losses of 
blood, have been renewed. The success which has 
crowned these efforts should encourage practitioners; for 
it is especially to these cases, entirely desperate, that the 
maxim of Celsus is applicable, "satius est anceps experire 
auxilium, quam nullum. " Organic alterations require a 
particular treatment. 

The predisposition to uterine haemorrhages is to be 
combated by the avoidance of the occasional causes, by a 
mild and moderate diet, sometimes even by local and 
general bleeding. 

HEMORRHOIDS. 

Symptoms. 
A flow of blood from the anus, coming not from the in- 
testines, but from the extremity of the rectum. This 
haemorrhage, which has considerable relation to the men- 
strual flux, is ordinarily preceded by weight of the head, 
by vertigo, by pains in the loins, by pains, itching and 
smarting, and the appearance of little tumours around the 
anus, and in the interior of the rectum. These livid and 
painful tumours, called haemorrhoidal, are not themselves 
the disease called haemorrhoids, they are only the conse- 
quence of the accumulation of blood drawn thither by ir- 
ritation. They have been divided into the blind, or the 
dry, and the bleeding, according as they are, or arc not 
followed by a flow of blood, and into external and internal, 
according to their scat. Haemorrhage may occur without 



204 THE PHYSIOLOGICAL 

the production of these tubercles. After these premoni- 
tory symptoms, some of which may be wanting, there oc- 
curs a flow of blood ordinarily moderate, and lasting for 
some hours, or for some days. This haemorrhage is, like 
the menstrual flux, ordinarily periodical, but it may have 
an irregular character. As the blood flows, the other 
symptoms diminish, and finally disappear entirely. 

In the dry haemorrhoids, the tumours form in the same 
manner as when they are bloody, they are preceded and 
accompanied by the same phenomena, with the exception 
of the flow of blood, or they only occasion a slight oozing, 
and then diminish and wither until the next congestion. 

Although haemorrhoids are very subject to relapse, they 
may only appear once or twice in the course of a life. 

Causes. 
Predisposing. — Middle age, plethora, the bilioso-ner- 
vous temperament, a hereditary predisposition, or an oc- 
casional particular irritability. Stimulants and gene- 
ral and local irritants, such as good cheer, drastic purga- 
tives, and particularly aloes; sedentary habits; riding on 
horseback; constipation, either on account of the efforts 
occasioned by going to stool, or on account of the obsta- 
cles which it presents to the circulation of the blood in 
the haemorrhoidal vessels; the same may be said of preg- 
nancy and accouchements, as also of diverse tumours, and 
engorgements of the abdominal viscera; chronic irritations 
of the digestive tube, and its appendages, which draws 
the blood into these parts, as we see in the greater number 
of hypochondriacs, who, as we have said in another place, 
are affected with these irritations; irritants introduced into 
the rectum, &c. 

Prognosis. 
In?.the great number of cases the haemorrhoids are a sa- 



PRACTICE OP MEDICINE. 205 

lutary operation of nature, especially when they are pe- 
riodical; the good health of the individual is dependant 
upon them so far, that their suppression, or even their 
delay, may occasion serious maladies. The development 
of the haemorrhoidal tumours is sometimes so considera- 
ble, that there result from it, as it were, a strangulation, 
which gives rise to a violent inflammation, and may de- 
termine gangrene if not promptly remedied. The hae- 
morrhoids, or rather the irritation which produces them, 
may likewise occasion various organic lesions in the mem- 
branes of the rectum and the adjacent tissues; but this ac- 
cident is rare. 

Treatment. 

In general the treatment of hemorrhagic irritations. To 
prevent haemorrhoids in subjects predisposed, we practice 
from time to time general bleeding; we advise a mild and 
vegetable regimen, aqueous drinks, abstinence from every 
stimulant, and moderate exercise. 

If the haemorrhoidal flux already exists with regularity, 
we must beware of arresting it, or of preventing its re- 
turn; we are in that case only to manage it in such a man- 
ner that the irritation may not invade the intestinal tube; 
if this irritation should supervene, we must apply twenty 
or thirty leeches upon the abdomen, about the point cor- 
responding to its seat. In case there should occur rupture 
of the large vessels and excessive haemorrhage, wc should 
first employ astringents, and should they prove ineffec- 
tual, have recourse to the ligature. Should the tumour be 
strangulated, we must refrain from the application of 
leeches, for experience proves that the irritation which 
thrir lutes occasion always increases the congestion; in 
such a case the application of ice, during some hours, to 
the tumour itself, is the surest means to arrest its develop- 
ment, and to prevent gangrene. Should the ice only be 
27 



206 THE PHYSIOLOGICAL 

applied during some minutes, there would be violent re- 
action, and the inflammation would proceed with redou- 
bled intensity. But if the anus be strongly contracted, 
without the existence of the tumours, it is the proper case 
for the full application of leeches, for emollient applica- 
tions, for general warm bathing, for the introduction of 
an anodyne cerate into the rectum. If the haemorrhage 
is excessive, or too often repeated, we may employ astrin- 
gents, the saturnine cerate, cold compresses. It will be 
readily conceived of how great consequence it is to ob- 
viate constipation, either by emollients or glysters, or by 
means of mild laxatives. 

HEMORRHAGES OF THE URINARY PASSAGES. 
(hematuria.) 

Symptoms. 
A flow of blood from the canal of the urethra, furnished 
by the kidneys, or by the bladder, and sometimes, but 
rarely, by the urethra; in this last case, we give it the 
name of urethrorrhagy. Particular signs enable us to a 
certain extent to determine these different sources. If the 
blood flows from the kidneys, the symptoms which pre- 
cede and accompany its emission, are very nearly the same 
as those of acute or chronic nephritis. (See Nephritic.) If 
it comes from the bladder, we meet with the symptoms 
of inflammation of this viscus,such as titillation or pain at 
the extremity of the penis, frequent desire to pass the 
urine, a sense of pain and weight referred to the perinseal 
region, and finally, a flow of blood. When the seat is in 
the urethra, the absence of the preceding symptoms, and 
the continual stillicidium of blood, leaves not the slight- 
est doubt as to the diagnosis. But the blood, from what- 
ever part, with the exception of the urethra, it may de- 
rive its origin, may accumulate in the bladder, and occa- 



PRACTICE OP MEDICINE. 207 

sion different symptoms, nausea, fainting, syncope, diffi- 
culty of discharging it, if it be formed into clots, an ob- 
stacle more or less complete presented by the clots to the 
emission both of the urine, and of the blood, which is not 
coagulated, pains, progressive in violence, of the lower 
belly, occasioned by the distention of the bladder, in a 
word, all the symptoms produced by the retention of 
urine. The duration of this malady is ordinarily long, a 
circumstance which is sufficiently explained by the causes 
which produce it. 

Causes. 
All those of the phlegmasia? of the urinary apparatus. 
Haematuria is sometimes observed to assume periodicity 
in its attacks, like the haemorrhoids. It may arise from a 
suppression of the latter, or of the menstrual discharge, or 
of any other habitual haemorrhage. 

Prognosis. 

When the blood comes from the kidneys, the prognosis 
is generally grave, for it is most frequently a sign of the 
presence of gravel, or of an organic and chronic alteration 
of these viscera; yet this haemorrhage may be nothing 
more than a sanguineous exhalation, arising from a state 
of vital exaltation of the kidneys or the bladder, or it may 
be the consequence of a solution of continuity, recently 
occasioned by a fall, by blows, by efforts, &c; in these 
cases, the cure is generally effected with ease. These ob- 
servations are all applicable to haemorrhages which have 
their seat in the bladder. 

Treatment. 
The treatment varies with the causes. If the flow is 
owing to the presence of calculi in the kidneys or to chronic 
alterations of these organs, we employ the same treatment 



208 THE PHYSIOLOGICAL 

as in chronic nephritis. If it be produced by an acute ir- 
ritation, whether of the kidneys or of the bladder, we calm 
this irritation by general blood-letting, and by the appli- 
cation of leeches and cups upon the points corresponding 
to the seat of this irritation. Emollient drinks, diet, rest, 
the horizontal position, and fresh air. If the haemorrhage 
has been profuse, and it consequently becomes necessary 
to arrest it, and if the preceding means have not had this 
effect, we make cold applications to the abdomen and to 
the perinaeum, and use hot pediluvia and maniluvia, cold 
and moderately astringent drinks, and preserve the bowels 
in a soluble condition with mild laxatives. If the blood 
accumulates in the bladder, and the power of discharging 
it is wanting, we employ the catheter to remove the clots 
which oppose its exit, and in certain cases to overcome 
the constrictions of the canal of the urethra; we employ 
emollient injections to dissolve these clots. If there be a 
calculus, its extraction is to be effected by appropriate 
means. 

If the haemorrhage has become periodical, which is a 
very rare case, we should not try to suppress it; however, 
if it be vicarious to another haemorrhage, for example, to 
the menstrual or haemorrhoidal flux, we should try to re- 
call it to its primitive seat. 

CUTANEOUS HEMORRHAGE. 
(diapedesis.) 

An exhalation of blood through the tissue of the skin 
is an extremely rare affection. It is, at one time, pre- 
ceded by heat, tension, and redness in the parts which are 
to be the seat of the affection ; at another time it makes its 
appearance in indolent spots, of a livid red colour, which 
permit more or less blood to ooze out. In the greater 
number of cases, the spots or ecchymosis take place with- 



PRACTICE OF MEDICINE. 209 

out an effusion of blood, and are most frequently the 
symptoms of a scorbutic affection. 

Treatment. 
If this affection be the consequence of an inflammation, 
whether external or visceral, we must not attempt to ar- 
rest it by means of astringent topical applications, which 
might determine a dangerous repercussion; we must then 
be satisfied with the employment of the antiphlogistic 
treatment. If it be owing to a scorbutic affection, we re- 
sort to the treatment demanded by this malady. (See 
Scurvy.) 

HEMORRHAGE OF THE GUMS. 

This haemorrhage may be the effect of a simple inflam- 
mation, of the gums, and in that case it requires no pecu- 
liar treatment, (see gengevitis,) or the result of a scorbu- 
tic affection, (see scurvy.) 

HEMORRHAGE OF THE SEROUS MEMBRANES. 

(OF THE PEIHTOITffiUM AND OF THE PLEDHA.) 

The haemorrhages of the serous membranes are very 
rare, and their signs so obscure, that for the most part 
their existence is not discovered until after death. In this 
place we can only treat of the exhalation of a bloody li- 
quid, occasioned by inflammation, and not of an extrava- 
sation of blood produced by a solution of antinuity, or 
furnished by another organ. 

Symptoms. 
Of Peritoneal Hemorrhage. — We can to a certain 
point distinguish between an effusion of blood and ascites, 
by the fact, that the haemorrhage is generally very ra- 



210 THE PHYSIOLOGICAL 

pid, and consequently the swelling occasioned by it; there 
are besides intense and sometimes lacerating pains, super- 
vening suddenly; a profound alteration of the physiog- 
nomy; coldness of the body; fear of death; delirium; 
faintness; syncope. 

Of Pleuritic Haemorrhage. — When the effusion takes 
place in the pleura, it is almost always attended with 
haemoptysis; there are also intense pains; an oppression 
which supervenes rapidly, and is constantly progressive; 
a dull sound of the thorax over the part corresponding to 
the effusion ; an absence of the murmur of respiration. If 
effusion occurs in the pericardium, there is orthopncea; 
an irregular and unequal pulse; an impossibility of per- 
ceiving the motions of the heart under the hand; some- 
times general oedema, and bloody sputa. But we repeat, 
that these signs are very obscure, and many among them 
are common to other affections. 

Causes. 
The same as those of the inflammation of the serous 
membranes that furnish the blood. (See Peritonitis, Pleu- 
risy, and Pericarditis.) 

Prognosis. 
In the greater number of cases these affections termi- 
nate in death. The danger is greater when these haemor- 
rhages come on in the train of chronic irritations, which 
have passed to the acute state, than when the membranes 
have not suffered degeneration from preceding inflam- 
mations. 

Treatment. 
Topical bleeding, sometimes preceded by general, par- 
ticularly if the inflammation is violent; no stimulants; 
when the weakness is extreme we employ cold internally 



PRACTICE OF MEDICINE. 211 

and externally, and apply revulsives to the inferior and 
superior extremities. 

RETENTION, DIMINUTION, OR SUPPRESSION OF PERIODICAL 

HEMORRHAGES. 

We have seen that haemorrhage is often the remedy 
employed by nature to dissipate an inflammation, and that 
it does not in reality beeome a morbid affection, but when 
it exceeds certain limits. If this haemorrhage does not 
take place, and if we do not supply its place artificially, 
inflammation pursues its ordinary course. 

In the same manner, when an organ becomes periodi- 
cally the seat of congestion, the blood flows, and the con- 
gestion is dissipated. If the blood does not flow, it is 
either because the irritation which had caused the conges- 
tion, has risen to the inflammatory degree, or what is 
more generally the case, because the blood has been 
drawn to other parts by the inflammation which has been 
developed there, or finally, because it has found another 
outlet. 

Every month, in young women, the uterus, which en- 
joys great vital activity, becomes the centre of a sangui- 
neous fluxion: if conception takes place, this exuberance 
of blood is applied to the end which nature proposes, that 
is, to the development of the foetus, of the placenta, and of 
the womb itself; and during this time there is no haemor- 
rhage. If there be no impregnation, this blood escapes, 
and the usual state is restored, until the occurrence of the 
next congestion, the real explanation of which is to be 
found in the natural irritability of the uterus. Now, if 
the woman be affected by a pneumonia, by a gastritis, or 
another inflammation, the blood in place of flowing to- 
wards the womb, will be drawn to the inflamed tissues, 
and retained in them, and often under tlic.se circumstances 
the menstrual flux will not occur. The same effecl may 



212 THE PHYSIOLOGICAL 

likewise be produced by the sudden suppression of the 
transpiration, because in that case the action of the skin 
repeating itself on the viscera, the blood is turned from 
its normal course, to throw itself upon the viscera, which 
arc in a state of sur-excitation. The same remarks are ap- 
plicable to any other cause, which has a tendency to dis- 
turb the order of the corporeal functions. When at a 
more advanced period of life, from the age of forty to 
fifty, the matrix loses its activity, and its tissues become 
more condensed, and less irritable, the congestion by de- 
grees ceases to occur, and the menstrual evacuation finally 
disappears, never to return. What takes place in the 
case of the menstrual flux, likewise occurs in the hemor- 
rhoids. It is a way of discharge which rids the body of 
an overplus of energy, and maintains in it the equilibrium 
necessary to health. The hemorrhoidal vessels, like the 
uterus, become the seat of a periodical congestion: another 
inflammation may in the same manner prevent this con- 
gestion, and the hemorrhoids may thus be suppressed. 
We have said in one of the preceding articles, that 
haemorrhages, although of the same nature as inflamma- 
tion, should be regarded as a lower degree of it; according 
to this principle, hemorrhage will not occur in acute in- 
flammation of the uterus, and this inflammation will be 
the cause of the suppression: in like manner acute inflam- 
mation may supervene solely on account of the retention 
of blood, which forms its real aliment. 

Besides the hemorrhoids and the menses, there may 
exist other habitual hemorrhages, but these cases are very 
rare. The same causes produce their suppression. 

AMENORRHffiA, OR DYSMENORRHffiA. 

When the menstrual flux does not make its appearance 
in girls at the natural epoch of life, (between the ages of 



PRACTICE OP MEDICINE. 213 

twelve and sixteen,) we say there is retention of the 
menses. If they are suppressed by an accidental cause, 
or if the flow of blood is attended with difficulty, we call 
this disorder amenorrhoea or dysmenorrhcea. The causes, 
the symptoms, and the treatment, being the same in these 
last cases, it is unnecessary to describe them separately. 

Symptoms. 
The pathognomonic sign is the absence of the haemor- 
rhage which should take place; but it is accompanied with 
an infinity of other disorders, which may either accom- 
pany each other, or exist in an isolated manner; such are 
pains in the loins, sense of weight in the lower belly or 
perinaeum; women experience at the ordinary epoch, the 
same phenomena as though they were about to have their 
monthly discharge, but the flow does not occur; pruriency 
of the sexual organs, acute or chronic irritations, having 
their seats in different parts of the body, in the brain, the 
lungs, the heart, and particularly the alimentary canal. 
We recognise these irritations by the signs that are proper 
to them; sometimes there are symptoms of hysteria, dys- 
pepsia, voracious appetite, or anorexia, depravation of 
taste, discoloration of the skin, paleness of the lips, gene- 
ral weakness; this constitutes the chlorosis of authors, pro- 
duced by a chronic gastritis; palpitations, syncope, some- 
times a vicarious haemorrhage supervenes in another part of 
the body, from the nose, the lungs, the stomach, the anus, 
thf: bladder, the gums, and in some rare cases from the eyes, 
the ears, tbe breasts, tlie ends of the fingers, and the sur- 
face of ulcers. 

I Causes. 

They may exist in the uterus itself, or what is more 
frequently the case, in other parts of the body. In the 
uterus we find acute or chronic inflammation, organic al- 
28 



214 THE PHYSIOLOGICAL 

terations, scirrhus, cancer, dropsy, &c. We do not here 
take into consideration the state of pregnancy, or of suck- 
ling, which are natural and not morbid causes of the sup- 
pression of the menses. The other causes are, as we have 
already seen, affections of different kinds, the seat of which 
is in other organs, whither the blood is determined; and 
consequently, every thing that can produce these affec- 
tions, may be ranked among the causes; sudden cold, a 
strong moral impression, such as sudden alarm, disagree- 
able intelligence, shame, anger, &c; the immersion of the 
feet or the hands in cold, and even, in the case of some 
women, in warm water, the want of exercise, &c. the 
abuse of internal stimulants. In a word, amenorrhoea be- 
ing considered in the greater number of cases as the result 
of an irritation in another part, may be occasioned by all 
the common causes of inflammation. 

Treatment. 

When the amenorrhoea is occasioned by an inflamma- 
tion, for example, by an acute or chronic pneumonia or 
gastritis, we must calm these irritations by the appropriate 
modes of treatment, and the haemorrhage will almost al- 
ways reappear. We see that in the greater number of 
cases the treatment of amenorrhoea is nothing more than 
that of the disease which is the cause of it. By this, how- 
ever, it is not to be understood that we are to neglect to 
recall the suppressed evacuation, for in occasioning a re- 
turn of the blood to its natural emunctory, we are at the 
same time calming the irritation which is drawing it to 
another point, or retaining it there. 

The means most conducive to this end are running, 
dancing, riding, if the person can practice it, warm bath- 
ing of the parts, warm fomentations and cataplasms to the 
lower belly, electricity directed to the sexual organs, lax- 
ative lavements, leeches to the perinaeum or the vulva, to 



PRACTICE OF MEDICINE. 215 

the number of tea or fifteen every month, until the flow 
be re-established, and above all, coition, if circumstances 
do not forbid; we must except the case in which the womb 
itself is the seat of an inflammation, whether acute or 
chronic. 

With regard to emmenagogues, the substances to which 
we give this name are irritants or stimulants, sometimes of a 
very energetic character, and, as in a great number of cases 
amenorrhoea is co-existent with an irritation of the diges- 
tive tube, these substances augment this irritation, or give 
rise to it when it does not already exist. Moreover, do 
not stimulants received into the intestinal canal, always 
augment irritations seated in organs even at a distance, 
whenever they fail in operating a revulsion? And if they 
augment them, how shall they cure amenorrhoea, of 
which these irritations are the true causes? Furthermore, 
experience perfectly confirms this theory,and there are few 
except physicians destitute both of theoretical and expe- 
rimental knowledge, who behold in emmenagogues the 
specifics of amenorrhoea. 

It is not, however, intended to assert that stimulants 
should be entirely banished from the treatment, but the 
first care of the physician should be to combat the inflam- 
mation of the head, of the chest, of the intestinal canal, of 
the liver, of the kidneys, of the womb, &c. and it is only 
after having triumphed over the inflammation, or having 
much reduced it, that it is allowable to have recourse to 
saffron, to iodine, to the preparations of iron, to rue, to 
procure the return of the haemorrhage. It must not be for- 
gotten, that if these stimulants have a special action upon 
the uterus and determine congestion there, they are far 
from being without action on the digestive tube which re- 
ceives them, and which is itself, in the greater number of 
cases, the seat of the irritation which causes amenorrhoea. 



216 THE PHYSIOLOGICAL 



DEFINITIVE SUPPRESSION OF THE MENSES. 

In our climates the menstrual flow ceases about the age 
of forty-five, sometimes earlier and sometimes later. Or- 
dinarily this cessation takes place without a derangement 
of health, but it sometimes happens that the blood not 
finding its usual outlet, throws itself upon other organs. 
When this accident occurs, we always observe that the 
organs which become the seats of congestion, are those 
which have been most excited, most irritated, and the 
most frequently inflamed in the course of the life. Thus 
it is the liver and the digestive canal that are affected in 
women addicted to good cheer and to spirituous liquors; 
the lungs in those who have been often affected with 
cough, catarrh, or other bronchial or pulmonary irritations; 
an aneurism may supervene in those whose hearts have 
been subject to palpitations; cerebral affections, more or 
less grave, in those whose brain has been excited by grief, 
study, or any other cause; the uterus itself may become 
the seat of an inflammation, or of an engorgement, which 
may degenerate into scirrhus, cancer, &c. These and other 
accidents have occasioned the name of the critical age to 
be applied to the definitive suppression of the menses. 
When the blood is shared equally among all the parts, the 
health of the woman becomes firmer, and if she is of a soft 
lymphatic constitution, there sometimes results a plethora 
or an excessive embonpoint. 

In general the cessation of the menses should come 
about by the progressive decrease of the quantity of the 
discharge, by the intervals between the customary periods 
becoming greater and greater. Sometimes, however, in 
place of disappearing gradually, they cease suddenly, and 
are replaced during some time by a uterine catarrh, by 



PRACTICE OF MEDICINE. 217 

perspirations more or less abundant, or by some one of 
the disorders we have enumerated. 

When the menses are suppressed without accident, the 
physician has only to counsel the patient to attend to the 
laws of hygieine: but should the health be disturbed by the 
suppression, we must examine whether there be any or- 
gan in a state of inflammation, or irritation, and when we 
have ascertained the existence and seat of the irritation, 
we must attack it by suitable means; we must likewise 
supply the place of the menstrual evacuations, until the 
system be habituated to the suppression, by local bleed- 
ings at the perinaeum, the anus, or the vulva, and we shall 
take care that the abstraction of blood correspond with the 
menstrual periods. General bleeding should likewise, in 
some cases, be employed, according to the seat and inten- 
sity of the inflammation which may be developed: in cer- 
tain cases recourse should be had to revulsives, more fre- 
quently external than internal, and if the case requires it, 
we may establish an issue. A mild and moderate milk 
or vegetable diet, abstinence from stimulants, a country 
residence, and muscular exercises contribute to the pre- 
servation of the strength, to re-establish it when inter- 
rupted, and to prevent plethora, and too great a degree of 
embonpoint. The woman should in the mean time avoid 
all the causes of excitement, which might act upon an or- 
gan affected with inflammation, or disposed to become so; 
such are frequent venereal indulgence, violent passions, 
and every thing that can prevent the movement of the 
blood towards the periphery of the body, crowd it upon 
the viscera, and create congestion in then), such as cold, 
corsets, belts, or other parts of dress worn too tight. 

SUPPRESSION OF THE HEMORRHOIDAL FLUX. 

Although haemorrhoids do not, like the menses, con- 
stitute a normal function, yet when they have become 



218 THE PHYSIOLOGICAL 

habitual, their suppression may give rise to affections re- 
sembling those which accompany the suppression of the 
menses, or to speak with greater physiological exactness, 
this suppression is most frequently the index of an irrita- 
tion which has drawn the blood to another point. The 
principle of these suppressions is always identical. The 
conduct of the physician must therefore be the same as in 
the preceding cases; that is, he should treat by appropriate 
means the irritations developed in other parts, recall the 
evacuation to its primitive seat, or if it be definitively 
suppressed, supply its place by the application of ten or 
twelve leeches to the anus, repeated during some days at 
the ordinary epochs of the flux. Practitioners likewise 
advise the use of purgatives, and particularly aloes; this 
substance indeed has a special action upon the rectum, 
but, as it is very irritating, it should not be employed, 
except when the alimentary canal is perfectly sound. 
Galvanic electricity, directed in a suitable manner upon 
the anus, is not to be contemned as an irritating means, 
calculated to produce a congestion in this part. If the 
haemorrhoids are suppressed without accident, we do not 
endeavour to re-establish them ; but as most of the persons 
who are subject to them, have at the same time a certain 
degree of irritation of the digestive organs, which this 
haemorrhage tends periodically to dissipate, it follows that 
even in the most favourable cases, those who are affected 
with it should avoid irregularities of living, and an abun- 
dance of aliment, which would not fail to excite and irri- 
tate the mucous membrane of the intestines, or to deter- 
mine plethora, two circumstances which render the hae- 
morrhoidal flux necessary in persons predisposed. 

NERVOUS IRRITATIONS. 

We may say with rigour, that there is nervous irrita- 
tion every time there is pain, and it appears that in the 



PRACTICE OF MEDICINE. 219 

majority of cases, the stimulating or irritating causes exert 
a primary action upon the nervous system, and that it is 
only through its intermediacy that the irritation reaches 
the other systems. Thus the exaltation of sensibility is 
the first symptom of inflammation, and the congestion of 
blood is afterwards determined. But there are cases in 
which the nervous centres, or their ramifications are alone 
or at least specially affected. 

In some of these cases, all physicians agree in recog- 
nising a perfect identity of the nervous diseases and in- 
flammation, for all the world agree that an encephalitis or 
a spinitis are a real inflammation of the brain and spinal 
marrow. But their sentiments diverge when the signs of 
irritation are less prominent. Yet we are naturally led to 
range these maladies in the class of irritations, or, if the 
expression be preferred, of sur-excitations; first, because 
they are ordinarily developed under the influence of the 
same causes as inflammation ; secondly, because they often 
yield to the antiphlogistic and revulsive treatment; third- 
ly, because they may succeed another mode of irritation, 
or an inflammation, or an haemorrhagy, and vice versd; 
fourthly, because the phenomena which we call nervous, 
evidently indicate a state of sur-excitation; and if there 
are symptoms of debility, this debility is often but appa- 
rent, and the result of an oppression of the vital forces, 
depending upon an inflammatory congestion, or an orga- 
nic alteration, the effect of congestion, such as apoplexy 
and palsy; fifthly, because dissection has demonstrated 
that in a very great number of cases of neurosis and neu- 
ralgia, or of maladies considered such, the organic disor- 
ders were of the same nature as those which result from 
any other inflammation, and if, in some cases, these de- 
rangements of structure have not been met with, we should 
nevertheless ascend by analogy from a similarity of facts 
to a similarity of causes. The nature of nervous affections 



220 THE PHYSIOLOGICAL 

being given, it only remains to determine their seats; 
now in proceeding analytically, as has been done with re- 
gard to feVers, we discover with regard to these irrita- 
tions, these acute or chronic nervous affections, as well as 
the organic alterations which they produce, or which de- 
termine them: 

First. That they have their seats in the nervous cen- 
tres; the brain and the spinal marrow, (encephalitis and 
spinitis.) 

Secondly. That they may be confined to one only, or 
to several of the nerves of sensation and locomotion, with- 
out the intervention of any cerebral or spinal affection; 
this is what occurs when the inflammation or the disorgani- 
zation attacks exclusively these nervous branches, or when 
these nerves, either in their course or at their origin, 
plunge into a focus of inflammation; such are often cases 
of neuralgia, of partial palsies, certain lesions of the sense 
of sight, of hearing, of taste, or of smell. 

Thirdly. That the irritations of the pectoral or abdo- 
minal viscera, often derange the functions of the nerves 
which they receive, whether from the grand sympathetic 
or from the pneumogastric, and give rise to neuroses af- 
fecting the functions of organic life, in the same manner 
as disorders of the brain and spinal marrow produce dis- 
turbance of the functions of the nerves which depend upon 
them, and give rise to neuroses, which may be denomi- 
nated neuroses of relation. These neuroses manifest them- 
selves in a thousand manners, according to the nature of 
the diseased organ, its structural alteration, and individual 
irritability; thus, there are sometimes palpitations of the 
heart, on account of an inflammation of this organ, or of 
an obstacle to the circulation of the blood; at 'other times 
patients experience suffocation, attacks of asthma, of 
hooping-cough, of the disease called angina pectoris, occa- 
sioned by an irritation of the respiratory organs, or of the 



PRACTICE OF MEDICINE. 221 

heart, or of these two viscera simultaneously. A chronic 
irritation of the digestive tube in an irritable subject, may- 
occasion the formation of gas, a sensation of constriction, 
symptoms of hypochondriasis, &c; the irritation of the 
womb gives rise in delicate women to the phenomena of 
hysteria, &c. 

As the irritation of the nervous centres extends its in- 
fluence over all the branches, so likewise the local irrita- 
tion of one or more nervous branches may react upon 
these centres; there then result phenomena similar to 
those we observe in the primitive irritations of these same 
centres; it is thus that an epilepsy may be determined by 
a puncture, a laceration, or a contusion of a nerve situated 
at a distance from the spinal marrow, because this local 
irritation reacts upon the spinal nervous mass; it is in this 
manner, likewise, that a lesion, or a mechanical compres- 
sion of a nerve of the hand, of the foot, &c. may give rise 
to an attack of epilepsy, because this irritation reacts upon 
the brain, which then induces the whole series of pheno- 
mena which constitute epilepsy. The irritation of the 
viscera also in certain cases produces an intervention of 
the actions of the nervous centres; it is thus that the chest 
agitates itself convulsively to satisfy the want of respira- 
tion, of coughing, of sneezing, in the attacks of asthma, 
of hooping-cough, &c; it is thus too that the muscles of 
the abdomen relax or contract themselves to follow the 
variations of the intestines, when the irritation of which 
they are the seat produces tumefaction or eonstriction, 
fixed or moveable pains. In these cases, and in others 
analogous to them, the brain is solicited by the visceral 
suffering, and the will is compelled to succour the dis- 
eased organs, in abandoning to them the action of the 
muscles of which they have need. It may then happen 
that the nerves of relation lend their assistance in many 
irritations, without either their own participation, or that 
29 



222 THE PHYSIOLOGICAL 

of the brain, in this irritation; that is, there may exist, 
and there do really exist, convulsions and spasms, although 
the brain and the nerves, subject to its influence, are in a 
state of perfect integrity. We readily conceive, that the 
more irritable individuals are, the more readily will the 
diseases of the viscera occasion a consenting action of the 
other parts, on account of the facility with which the im- 
pressions they experience repeat themselves upon the sen- 
sitive centre. In individuals endowed with great mobility, 
and who on this account are called nervous, neuroses may 
occur without the intermediacy of irritated organs, and by 
the effect alone of a passing excitation of the nervous centre. 
The sense of suffering produced by a diseased organ, may 
be instantaneously produced by any other cause acting 
directly upon the brain: it is thus that a powerful emo- 
tion, a strong odour, the sight of an object which gratifies 
or offends, may determine a nervous attack. This is ob- 
served particularly in persons in whom visceral suffering 
has often awaked nervous sensibility, which sensibility 
afterwards responds to the action of a great number of 
causes besides those derived from the organ, which forms 
as it were the point of departure. But the train of events 
is not always as we have just described it; in a very great 
number of cases, the inflammation of the viscera deter- 
mines that of the brain, and in these cases the cerebral 
neuroses are associated with those of the viscera. These 
phenomena occur principally in irritations of the abdomi- 
nal viscera. In the case of the acute stages, authors do 
not give the name of nervous affections to the group of 
symptoms which result from this association of visceral 
and cerebral irritation, but. we have what they denominate 
malignant, ataxic, adynamic, and cerebral fevers. As the 
ancients were mistaken with regard to these fevers, so like- 
wise they have been in error with respect to the nature 
of these pretended neuroses produced by the chronic irri- 



PRACTICE OF MEDICINE. 223 

tation of the same organs; the whole difference eonsistsin 
the greater violence of the nervous symptoms in the acute 
than in the chronic state; but in both cases, it is always 
an irritated organ that disturbs the others; in hypochon- 
driasis, the digestive organs are the source of derange- 
ment; in hysteria, the uterus; in asthma, the organs of 
respiration; in palpitations, the heart, &c. This disor- 
der, this cry of the organs, is repeated in the brain, which 
receives the irritation, and transmits it by the nerves to 
the muscles, where it manifests itself by convulsions, 
faintings, &c. 

All that has been hitherto said, tends to demonstrate 
that the diseases called nervous are referable to the same 
■causes as other maladies; that their nature is identical; 
that is, that they depend upon an excitation, an irritation, 
•or an inflammation, affecting in some cases a nervous cen- 
tre, in other cases, one or more of its ramifications; in other 
cases they depend upon the inflammation of one or more 
viscera, acting upon the nervous centres, with a degree of 
intensity proportioned to the mobility and irritability of 
constitution possessed by the individual. 

The mobility of the neuroses has been objected to this 
theory; but fixity of seat is not a distinctive character of 
inflammation. Erysipelas, ophthalmia, articular affections, 
the inflammatory nature of which no one pretends to 
doubt, are often displaced with the greatest facility. The 
intermittent character of the pain ordinarily observed in 
nervous affections, has no greater tendency to disprove the 
preceding prepositions. It is not essential to inflammation 
that it be continued; most of our functions are performed 
with a species of intermittence in their normal order; such 
are menstruation, and some other sanguineous evacuations, 
sleep, the desire to eat, and to pass the urine and faeces; 
many maladies evidently inflammatory, congestions, &c. 
appear in an intermittent or remittent form. Why should 



224 THE PHYSIOLOGICAL 

not the same be the case in nervous inflammations and ir- 
ritations? 



GENERAL VIEW OP THE TREATMENT OF NERVOUS IRRI- 
TATIONS. 

It follows from these principles, of the grounds of which 
the limits of this work do not permit us to make a more 
detailed exposition, that when the physician has to treat 
an affection of the kind they denominate, whether rightly 
or wrongly, nervous, it is proper for him first to assure 
himself of the seat of the inflammation, and when that has 
been ascertained, to treat it by appropriate means. Should 
the irritated organ, or tissue, or the diseased part into which 
the nerve plunges, be in a true state of inflammation, we 
treat the disease with emollients, local, or even general 
blood-letting, the warm bath, in one word, with a regimen 
decidedly antiphlogistic, as in inflammations without neu- 
rosis. Should the irritation not have reached the degree 
of inflammation, we still employ the same means, but we 
abstract blood less freely. 

When, by means of this treatment, we have diminished 
the state of inflammation, or of irritation, revulsives may 
be employed with success. 

It often happens that the local irritation being destroy- 
ed, there remains to be corrected a convulsive habit which 
survives it. This may be combated by certain stimulants 
which they call antispasmodics, such as ether, camphor, 
musk, opium, assafoetida, valerian, zinc, &c. but it is pro- 
per to add that these means are rarely of permanent or 
decisive utility; that most frequently they only palliate 
the evil by producing a sur-excitation and perhaps a tem- 
porary revulsion ; that they often augment it; in fine, that 
after antiphlogistics and revulsives, the most efficacious 
means, in a great number of cases, are muscular exercise, 



PRACTICE OP MEDICINE. 325 

amusement, travelling, and the exertion of the will, which 
alone is sometimes sufficient to resist what they call ner- 
vous attacks. In compelling the muscles to act under the 
influence of the will, we throw upon them the excess of 
vitality which torments the nervous system, we render it 
less sensible to the stimulation of the viscera; we augment 
digestion, nutrition, and the depuration of the blood, at the 
same time that we reduce the nervous activity; for the 
more an individual expends of his activity in voluntary 
movements, the less has he remaining for the sensations 
and involuntary movements; by exercise the constitution 
becomes stronger and affords less opportunity of making 
an impression to the causes that tend to create this trou- 
blesome sensibility, upon which depends a number of 
neuroses. 

If, as it sometimes happens, paralysis succeeds the ner- 
vous sur-excitation or irritation, stimulating remedies, 
such as friction, douching, blisters, the application of fire, 
cups, electricity, acupuncturation, and electropunctura- 
tion, &c. are suitable upon the parts which have lost mo- 
tion and sensibility; but if the paralysis depends upon a 
lesion of the nervous centres, every kind of medication, 
directed to the nervous branches, will be completely 
thrown away. Besides this, we know that these disorga- 
nizations, whether cerebral or spinal, the results of pre- 
ceding inflammation, consist in softening, suppuration, 
compression, or induration; now, if these disorders have 
no great extent, nature works their cure: it is therefore 
our part to favour her efforts, and not to interfere with 
her operations, by irritating the brain and provoking a 
new effusion, a new congestion, or a new inflammation in 
the tissues which were disposed to become healthy. The 
best practice under these circumstances, is to employ no 
internal irritant, to put the patient upon a light regimen, 
which may sustain him, without causing sur-excitation, 



226 THE physiological' 

to enjoin abstinence from intellectual labour, to make him 
take the fresh air, seconded by exercise proportioned to 
his remaining strength. In paralytics whom apoplexy has 
spared, it is a good plan to resort to a general abstraction 
of blood from time to time, to prevent the recurrence of 
congestion; revulsives are still suitable after the antiphlo- 
gistic treatment, in the acute or chronic inflammations that 
threaten the disorganization of the nervous trunk; thus 
we apply the moxa, cups, the needles, &c. over the course 
of the sciatic nerve in nervous sciatica; to the arm, to the 
forearm, to the temples, and so forth, in neuralgia of these 
different regions. 

It is extremely uncommon to meet with affections 
purely nervous. In the great majority of cases they are 
complicated with inflammation or lesion of some neigh- 
bouring tissue. 

Does the sur-excitation of the nerves and of the muscu- 
lar system placed under their dominion, and the state of 
collapse which very often succeeds, depend upon the ac- 
cumulation of the nervous fluid in certain points, on the 
restoration of the equilibrium of this fluid, and upon its 
subtraction? Many facts would incline us to answer this 
question affirmatively; but in the actual state of our know- 
ledge it is not possible to assert it as a demonstrated pro- 
position. Whatever may be the fact, the influence of elec- 
tricity upon the nervous system, as well atmospheric as 
that produced by the machine, cannot be questioned. 



PRACTICE OF MEDICINE. 227 



AFFECTIONS OF THE NERVOUS CENTRES. 

IRRITATIONS OF THE BRAIN AND ITS ENVELOPES. 

(Encephalitis, Meningitis or Phrenitis, Gastro-cerebri- 
tis, Apoplexy, Paralysis, Epilepsy, Catalepsy, Ce- 
phalalgy, Mental Alienations, Nostalgia, fyc.) 

An acquaintance with cerebral irritations is very im- 
portant, on account of the part which the encephalon per- 
forms in the organic economy, and because it is the cen- 
tre of the intellectual functions, the director and excitor 
of innervation. 

The irritations of the brain may assume forms extreme- 
ly varied, which for a long time were regarded as affec- 
tions sui generis; but when we reflect that these diverse 
forms depend only on the intensity of the irritation, on 
its seat, occupying either the whole encephalic mass, or 
the meninges, or some parts of the cerebral pulp, upon 
extravasations, sanguineous or otherwise, upon organic 
alterations resulting from them, upon diverse complica- 
tions of this irritation with that of other viscera, &c. it is 
impossible to admit this long and useless nomenclature 
of cerebral maladies, with which authors have surcharged 
their nosological tables. 

Cerebral irritations are acute or chronic. Although it 
is not always easy to trace the line of demarcation be- 
tween these different states, although the passage from the 
one to the other is a very frequent occurrence, and al- 
though there are between extreme acuteness and chroni- 
city, many intermediate degrees of irritation, yet we 
shall admit this division as being the most simple. 



228 THE PHYSIOLOGICAL 



ACUTE CEREBRAL IRRITATIONS. 

ENCEPHALITIS AND ARACHNITIS. 

Symptoms. 
Pains more or less acute in one or more points of the 
cranium, ordinarily fixed about the forehead and occiput; 
lancinating, if the inflammation occupies the meninges; 
dull, undefined, profound, if the cerebral mass be the 
seat of it; pulsation of the carotid arteries; burning heat 
of the skin; eyes animated, projecting, suffused; dilatation 
and immobility of the pupil; fixed aspect, dull or fero- 
cious. To these local symptoms others are added, if the 
irritation rises to a very high degree. There is delirium, 
which may even become furious ; vertigo ; terrifying 
dreams, such as the sight of flames, precipices, monsters, 
&c. There are sometimes convulsions; tetanus; subsultus 
tendinum; cold of the extremities; cold sweats, or pun- 
gent heat of the skin. Considerable exaltation of muscular 
energy; menacing aspect; this is the ardent fever of au- 
thors. It is rarely the case, that encephalitis pursues its 
course alone; most frequently gastritis precedes it, or de- 
velopes itself under its influence: either of these two irri- 
tations may be sympathetic of the other, according to the 
order in which they succeed each other. If the gastric 
affection predominates, the irritation of the brain, instead 
of manifesting itself by symptoms of augmented vital 
force, is accompanied by prostration: this is the adynamic 
or ataxic fever. If this irritation does not continue suf- 
ficiently long to produce disorganization before the fatal 
termination, this malady is ranked, but incorrectly, in the 
number of essential diseases. Nervous phenomena, such 
as frenzy, delirium, convulsions, in one word, exaltation 
of all the cerebral functions, are always signs of inflam- 
mation of the brain, or of its envelopes. If the phlogosis 



PRACTICE OF MEDICINE. 229 

lasts but a short time, it carries off the patient, without 
producing profound organic lesions; but, notwithstanding 
the absence of these lesions, the malady is not more essen- 
tial in the one case than in the other. Arachnitis may 
often be confounded with cerebritis, but this error is of 
no consequence in a practical point of view, for the plan 
of treatment is absolutely the same in the two cases. 

Causes. 
Irritation often arrives at the brain through the mem- 
branes that form its envelope; at other times, it is the sequel 
to irritation of the neighbouring parts; thus inflammation 
of the ear, of the eyes, of the nasal cavities, of the inte- 
guments of the head, may extend to the brain; this phe- 
nomenon of extension is common to all the phlegmasia?. 
It is also determined by sympathy. No organs have a 
more intimate relation to each other than the brain and-the 
stomach; it is on this account that gastritis developes with 
so much facility inflammation of the brain, and that, if a 
moral influence, or any other cause acting directly on the 
brain produces a meningitis, or a cerebritis, however slight 
may be its intensity, this irritation repeats itself always 
upon the digestive organs: whence it follows that all the di- 
rect causes of gastritis may give rise to cerebral irritations, 
and vice versd. We have spoken in another place of the 
causes of gastritis; we shall not repeat them here. The 
direct excitants of the brain, and consequently the direct 
causes of encephalitis, are, intellectual labour, violent pas- 
sions, prolonged watching, insolation, exposure of the head 
to a heat too intense, external violence, certain obstacles 
to the circulation of the blood, particularly tight cravats, 
the sudden suppression of a haemorrhage or an issue. 

Prognosis. 

Acute arachnitis often terminates at the end of the fifth 
10 



'430 THE PHYSIOLOGICAL 

or sixth day, by a sero-purulent secretion on the surface 
of the arachnoid, and rarely by a complete resolution. 
The course of acute encephalitis is slower, and does not 
terminate often until between the eleventh and twentieth 
day, seldom also by complete resolution, but by passing 
into the chronic state, which may assume a variety of 
forms, as we shall presently see, according to the diversity 
of lesions produced. 

Treatment. 

Blood-letting here stands first, and should be employed 
from the commencement of the disease. If profound 
adynamy or ataxy exists, the abstraction of blood will 
prove injurious. We must abstract blood from the foot, 
and repeat the operation more or less frequently, in pre- 
ference to bleeding from the arm, experience having de- 
monstrated that this is the more efficacious mode of pro- 
ducing a depletion of the brain. We may have recourse 
to arteriotomy, to bleeding from the veins of the mucous 
membrane of the nose, either by means of two or three 
leeches, or by opening a nasal vein with the instrument of 
M. Cruveilhier; the application of a great number of 
leeches to the neck, to the temples, and behind the ears. 
It is very important to be assured of the point of depar- 
ture of the inflammation. If it be the effect of a gastritis, 
we apply leeches to the pit of the stomach. Silence and 
the exclusion of great light; cool temperature; temperant 
drinks; laxative lavements; severe diet; an elevated posi- 
tion of the head. 

Should iced applications be employed? Some prac- 
titioners condemn them, others recommend them in 
every case. The cause of this difference of opinion 
depends on the fact that physicians have not discri- 
minated between the cases in which this means is use- 
ful, and tho.se in which it is injurious, confounding 



PRACTICE OF MEDICINE. 231 

the constitutions of patients and the stages of tlfe disease; 
it depends in part also on their neglecting the precau- 
tions which the application of ice renders necessary, and 
especially their not taking into consideration the length 
of time the ice should remain upon the head. Experience 
has taught that the application of ice is injurious in indi- 
viduals who are weak, cachectic, with feeble powers of 
reaction, and prostrated by the duration of the malady; 
in infants whose fontanelles are not yet ossified, and who 
are of a lymphatic or scrofulous constitution. It is hurtful 
when the inflammation is of many days standing, when 
there exists signs of effusion, of softening, or of suppura- 
tion. It is, on the contrary, of the greatest advantage in 
robust subjects of a good constitution, and when the ma- 
lady is commencing; but to secure its good effects, we must 
permit it to remain a long time on the head, with the view 
of preventing the reaction which always succeeds seda- 
tion, and which occurs every time we remove it. Its ap- 
plication should then be continued until this reaction no 
longer occurs; this is not the case until nearly all the cere- 
bral symptoms have disappeared. 

We must not neglect revulsives, such as sinapisms to 
the lower extremities, pediluvia and maniluvia, rendered 
stimulating by mustard. 

SUB-ACUTE AND CHRONIC CEREBRAL IRRITATIONS. 

Acute inflammation of the brain may affect the whole 
encephalic mass, the meninges, or only some circumscrib- 
ed part of the cerebral substance. The same is the case 
with the sub-acute and chronic inflammations, but their 
forms are varied to such a degree that it would be impos- 
sible to describe them all. In general the organic symp- 
toms are few in number, and are most frequently limited 
to acute pains in the head, which are local, circumscribed, 



232 THE PHYSIOLOGICAL 

sometimes general, to vertigo, &c. The sympathetic symp- 
toms consist in the depravation of the digestive process, 
in the loss of a sense, in an exaltation of sensibility in an 
eye or an ear, in the convulsion or palsy of an arm, of a 
leg, of one side of the body, in pains of the muscles, &c. 
The integrity of the digestive functions may, however, 
continue, notwithstanding these symptoms; but if a gas- 
tritis supervenes, these functions will be deranged. 

In other cases there is aberration of the mental facul- 
ties. These aberrations may exist in diverse degrees, the 
first of which is delirium; this diners from mania only in 
intensity; they are not two separate entities. Thus, in 
acute inflammation, this delirium becomes violent, furious; 
there is loquacity, and augmentation of muscular strength. 
In a local phlogosis of the cerebral pulp, particularly if it 
is chronic, the intellect may long retain its integrity, but 
in that of the meninges, the intellectual faculties are soon 
disturbed, and there is mental alienation. It would be 
difficult to draw a line of demarcation between the cases 
in which the irritation produces delirium or mania, or 
only a kind of torpor of the mental faculties. The forms 
of mental alienation are innumerable, on account of the 
acute, sub-acute, chronic, general, or circumscribed in- 
flammation which determines them. 

The passions have the greatest relation to mental aliena- 
tion; their existence presupposes the association of cere- 
bral excitation with that of some organ, such as the heart, 
the stomach, the sexual apparatus. The brain being ex- 
cited, in its turn excites a given viscus, and this consti- 
tutes passion. Blood-letting, however, does not succeed 
in calming the passions, as it does in simple phlogosis, 
because this double excitation is ordinarily the result of 
an intellectual operation. Yet we sometimes see the 
erotic fury yield to general depletion and to mild re- 



PRACTICE OF MEDICINE. 233 

We have said that there existed between the stomach 
and the brain such relations that the irritation of the one 
is always repeated in the other; this is observed in many- 
cases of mental alienation. Religious, amorous, nostalgic, 
and other cases of delirium, are almost always accompanied 
with an irritation of the digestive organs. All these 
forms of cerebral irritation, from having been sub-acute, 
may become acute, rise even to a state of frenzy, and 
thence to apoplexy and paralysis; but these are not mala- 
dies of a distinct nature. Diminution of intelligence pre- 
cedes or follows apoplexy, encephalitis, and cephalalgy, 
as in the case of any other cerebral irritation. In all these 
cases there is disorder of the locomotive or intellectual 
faculties, or of these two faculties simultaneously. Mad- 
ness is gay, sad, or furious, according to the temperament 
of the individual, and according to the precise seat and 
the intensity of the cerebral excitation. .Those who are 
affected with sad and gloomy ideas, who imagine the in- 
fernal regions open beneath their feet, &c. are ordinarily 
sufferers from a gastro-cerebral irritation; the inclination 
to commit suicide is often an index of this irritation, and, 
although all suicides are not invalids or fools, many among 
them have the brain and digestive passages in a state of 
sur-excitation. Nostalgia, as we have already said, de- 
pends also on a similar irritation. It is true that a moral 
affection ordinarily precedes this irritation; but this moral 
affection is a stimulant to the brain; finally, this organ be- 
comes irritated, and the irritation exalting the sensibility 
of the seat of the idea which occupies the mind, this idea 
is incessantly represented, and causes an oblivion of all 
others. This appears to be the real cause why one indi- 
vidual is mad upon one particular point, and another upon 
a different one, in one word, the cause of monomania. 
Thus we observe a progressive failing of the understand- 
ing, and sometimes a gradual extinction of the passions. 



234 THE PHYSIOLOGICAL 

Whether we admit or not the doctrine of Gall, these ob- 
servations, which are, moreover, confirmed by dissec- 
tions, remain unshaken. 

Intermittent irritations of the brain often succeed the 
continued, although they may be primitive. Of this kind 
are epilepsy, certain cephalalgies, catalepsy, or exstacy. 
Catalepsy is most frequently met with in devotees, whose 
imaginations always excited, represent to them the joys 
of paradise, and bring to their ears the music of celestial 
choirs, &c. Although in this affection all the parts of 
the body are deprived of sensation and motion, and the 
limbs retain the position that is given to them, the sole of 
the foot sometimes retains much sensibility. This malady 
cannot find a place except among cerebral excitations. 

In epilepsy muscular movement is not extinct, but 
the sensitive faculties are suspended, and all the members 
are agitated with violent convulsions; the face is of a deep 
red colour, the mouth foaming, the respiration laborious. 
The attack having terminated, the patient remains for 
some time in a state of weakness and stupor, and gradu- 
ally returns to his natural state. Fright is the most fre- 
quent cause of it; then follows excessive venery, particu- 
larly at an early age; the suppression 'of an habitual eva- 
cuation; the presence of a foreign body; intestinal worms; 
the compression or laceration of a nerve, even at a point 
very remote from the brain. In this case it is the local ir- 
ritation that awakes that of the brain. Epilepsy, as all 
other forms of cerebral irritation already mentioned, may 
be primitive or consecutive. Do we wish a proof that this 
malady is the effect of a cerebral irritation? We have it in 
the fact, that after some time it leads to mania, idiocy, to 
apoplexy, or is consecutive to these affections. 

Cephalalgy or head-ache is sometimes continued, but 
most frequently periodical. We observe it to supervene 
under the influence of moral causes, of depressing passions, 



PRACTICE OF MEDICINE. 235 

and of all the excitants of the brain, of chronic gastritis, 
of the suppression or cessation of the menses, of haemor- 
rhoids, &c. Irritable brains are more subject to it than 
others. Cephalalfiu* may pass from the periodical .to the 
continued form, then to acute encephalitis, to apoplexy, 
or it may succeed these affections; it is then only a cere- 
bral irritation, which is exasperated and becomes sensible 
at intervals; to make of it a malady sui generis, would be 
an absurdity. Whatever may be the alterations of the 
brain, induration, softening, suppuration, sanguineous, or 
serous effusions, and whatever may be the remote disor- 
ders which result from these alterations, we must always 
recognise as their cause, irritation developed in diverse 
degrees in different subjects, in different parts or tissues. 

It often happens that chronic cerebral irritation rises 
suddenly to the acute state, or to apoplexy, and causes 
death. On dissection we then always find an effusion of 
blood under the meninges, or in the cavity of the ventri- 
cles, or even in the parenchyma of the brain. (See Apo- 
plexy or Cerebral Haemorrhagy.) 

If apoplexy does not occasion death, it is almost always 
followed by palsy, or by convulsive movements, or by im- 
pairment or disturbance of the intellectual faculties, affec- 
tions which in their turn often lead to apoplexy. It has 
been asserted that the alterations of the brain, which give 
rise to paralysis, are ordinarily found on the side opposite 
the paralyzed members; this assertion is contradicted by 
other observers; but this is of little importance in practice; 
it is in fact sufficient to know, that according as the effu- 
sions occur in one part or in another, there will result 
from it a partial palsy, or partial convulsions, or finally, 
apoplexy; that all these affections are of the same nature, 
and that primitive or consecutive apoplexy, no more than 
the paralysis that precedes or follows it, is a malady 
sui generis. 



236 THE PHYSIOLOGICAL 

After having classed together, under the same point of 
view, the different forms of chronic cerehral irritation, it 
is now proper to speak of their treatment. 

Treatment. 

First, the removal of the occasional causes. In all cases 
of a sub-acute character, the treatment should be antiphlo- 
gistic: the palsies and partial convulsions which are con- 
nected with a state of cerebral irritation, yield always 
more easily to this treatment, and to blood-letting, than 
to nervines. The abstraction of blood in the meantime 
is occasionally necessary to prevent cerebral congestion, 
which might occasion apoplexy. It is essential to recall 
to their primitive seats suppressed evacuations, by means 
of the application of leeches at the ordinary periods of 
these evacuations. This last practice is important, what- 
ever may be the external symptoms of cerebral irritation, 
palsy, tremblings, cephalalgy, epilepsy, madness, &c. If 
there is irritation of the alimentary canal, we pursue the 
treatment directed in such cases. We also have recourse 
to revulsives, after the employment of the antiphlogistic 
treatment and regimen: thus, we may place a blister on 
the back of the neck, and obviate constipation by means 
of emollient lavements, or drinks slightly laxative. We 
must not lose sight of the fact, that a great number of 
chronic irritations of the brain, being accompanied by se- 
rious alterations of its substance, physical and moral re- 
pose are the surest means of procuring the re-absorptions 
and cicatrizations necessary to obtain a perfect cure. 

In mental alienations, we must first observe the cause 
of these maladies. The cerebral excitation, produced by 
study, devotion, love, the recollections of home, should 
be treated by diversions, and sometimes by a compliance 
with the desires of the monomaniac; and if the irritation 
rise to the inflammatory degree, if there be furious deli- 



PRACTICE OP MEDICINE. 237 

rium, and if the individual be robust and plethoric, we 
have recourse to blood-letting, and are guided in the re- 
petition of it by the intensity of the cerebral phenomena. 
We must be careful not to exasperate the irritation, by 
contradicting maniacal patients. In many of these cases, 
the warm bath, with cold affusions on the head during its 
employment, may be useful, if the patient submits to the 
treatment with docility; if he resists, we should not insist 
upon it, lest we augment the cerebral excitation. 

In the periodical irritations of the brain, we particular- 
ly examine into the causes which produce them and keep 
them up. We shall call to mind, that in epilepsy it is 
very possible for this cause to be seated in a point remote 
from the brain, which in this case will only be irritated 
in a secondary manner. If then we ascertain the existence 
of worms, we cause their evacuation; we remove the com- 
pression of a nervous trunk; we extract splinters of bone, 
or other foreign matters, if they exist; the local or remote 
inflammation is to be combated by antiphlogistics and lo- 
cal blood-letting; plethora, by general depletion. 

It may happen, that after having combated the irrita- 
tion by blood-letting, and other antiphlogistic means, and 
even after having removed the causes, the brain still re- 
tains the habit of intermittent irritation: in this case we 
resort to diverse agents which modify the sensibility of 
the nervous system, or interrupt the periodicity of the ir- 
ritation: of this kind are the antispasmodics, such as assa- 
fcetida, valerian, camphor, the ammoniated copper, hydro- 
cyanic acid, &c. The sulphate of quinine, either alone, 
or in combination with these substances, has produced 
the most happy results. We commence by administering 
them in small doses, and gradually increase the quantity, 
or the frequency of repetition, carefully observing the 
state of the alimentary canal. These medicines are given 
in the interval of the attacks. The nitrate of silver in 
31 



238 THE PHYSIOLOGICAL 

curing the epilepsy always produces a gastritis, which is 
in every case dangerous; it has been discarded. Epilepsy 
is one of the most difficult affections to cure; yet local and 
general blood-letting at first, and afterwards antiphlogis- 
tics and quinine, produce cures in a great number of cases. 
In these obstinate cases, we add to the other means the 
employment of revulsives, such as blisters and sinapisms, 
which we apply successively to different parts of the 
body. During the attack, we should keep all powerful 
odours and all stimulants from the patient. When epi- 
lepsy is occasioned by a lesion remote from the brain, as 
the compression of a nerve in the finger, the access is or- 
dinarily announced by what is denominated the aura epi- 
leptica, and we can often prevent it by immediately 
placing a ligature upon the limb, between the point of de- 
parture and the brain. 

Catalepsy always demands a stimulating treatment, as 
well externally as internally; this has been demonstrated 
by experience. Cephalalgia or head-ache has often been 
successfully treated by quinine, administered during the 
absence of the attack; but we must suspend its employ- 
ment, if there exist or supervene signs of irritation of the 
digestive organs. There are practitioners who recommend 
the employment of opium, of emetics, of coffee, &c. 
during the attack; but we can never calculate with cer- 
tainty upon the effect of these substances, which are some- 
times hurtful, and sometimes beneficial: the best course 
to pursue then, is to keep the patient perfectly quiet, and to 
avoid light and noise. In women whose courses are irregu- 
lar, should suppression of this evacuation occur, we should 
recall it by the employment of leeches, with the view of 
preventing cerebral congestion, or the organic alterations, 
with which persons affected with obstinate cephalalgies are 
always threatened. The same precept is applicable to in- 
dividuals in whom the hemorrhoids are suppressed; and 



PRACTICE OP MEDICINE. 239 

even in persons who have never been subject to them, it 
would be very advantageous to establish a point of fluxion 
about the anus. The complications of gastritis, which 
exist almost always, should be combated by the ordinary 
means; revulsives, such as a large blister, an issue, a se- 
ton in the back of the neck, are also of great advantage 
in cephalalgy, as in most of the chronic cerebral affections. 
In cases in which chronic irritation returns to an acute 
state, the treatment should again be decidedly antiphlo- 
gistic. 

ACUTE ARACHNITIS OF INFANTS. 
(acute hydrocephalus of authors.) 

Symptoms. 

We have confounded in the preceding article, encepha- 
litis with meningitis, not because it is absolutely impossi- 
ble to distinguish them, but because this distinction is use- 
less in a therapeutic point of view. Meningitis or arach- 
nitis in infants requires a particular description. 

First Period. — At the commencement of the malady 
the patient is sad, agitated, dejected, tormented with acute 
head-ache, which it refers to the forehead, to the vertex, 
or to the occiput. This head-ache commences with re- 
markable somnolency; it is continued, but it becomes more 
acute by attacks of short duration, which sometimes draw 
from the infant cries altogether peculiar. After these cries, 
the infant falls again into its state of dejection and somno- 
lency, it sometimes grinds its teeth and chews as though it 
had threads in its mouth. It only rouses itself from its stupor 
to complain, and sometimes to rave. Motion increases the 
cerebral pain; the head is heavy, and falls backwards, or 
.upon the shoulders; the fades hears the impress of pain; 
the child has itchiness of the nose, starts suddenly out of 
sleep, is affected with strabismus, dilatation or constriction 



240 THE PHYSIOLOGICAL 

of the pupil, occlusion, almost permanent, of the eyelids, 
occasioned by the great sensibility of the eyes to light; 
sometimes efforts to vomit, obstinate constipation, and if in 
some rare cases there is a looseness, it is owing to a com- 
plication of entero-colitis; the urine is scanty and contains 
a sediment; alternation of flushing and paleness of the face; 
the pulse more frequent than in health, most frequently 
accompanied with a slow and irregular respiration. 

Second Period. — Augmentation of all the preceding 
phenomena, and particularly of the nervous symptoms ; 
convulsive agitation of the muscles of the face and of the 
limbs; the head-ache is more acute; the heat of the head 
is very great, and is accompanied with frequent and irre- 
gular flushings of the face; the pulsations of the arteries, 
before accelerated, now diminish in frequency, and are 
irregular, and this irregularity coincides ordinarily with 
very unequal respiration; the patient often raises his hands 
towards his head; the strabismus increases; the pupils, di- 
lated or contracted, oscillate in a remarkable manner ; the 
eyes are insensible to the light; the somnolency is pro- 
found and continual; the vomitings cease ordinarily towards 
the end of this stage, which is the longest one of the dis- 
ease. 

Third Period.— When this series of phenomena has 
continued during ten or fifteen days, the head-ache seems 
to have ceased entirely, and the infant falls into a profound 
coma, which is disturbed only by the grinding of the 
teeth, and convulsions of the face and muscles. The pulse 
becomes regular again, but is to a very extraordinary de- 
gree weakand frequent; theeyelids are half-closed, the ball 
of the eye is turned upwards; the respiration is slow and 
stertorous; cold sweats; cold extremities; death. 

Sometimes the patient is carried off by the convulsions, 
before having passed through all these stages. 



PRACTICE OP MEDICINE. 241 

Causes. 

Hitherto authors have given to this malady the name 
of hydrocephalus, on account of the sero-purulent collec- 
tions which they have found after death ; but this is to 
take the effect for the cause. This malady consists in an 
inflammation of the meninges, and especially of the arach- 
noides. It is not a question of great importance to the 
physician, whether the seat of this disease be in the mem- 
branes which cover the convexity of the brain, as happens 
generally in adults, or whether it be seated in those of 
the base and ventricles, as is frequently observed in in- 
fants: it is sufficient to know that there, is inflammation 
of the envelopes of the brain, that this inflammation very 
often extends to those of the spinal marrow, and that con- 
sequently all the causes of cerebral irritations may deter- 
mine it; such are difficult dentition, worms, falls, and 
blows upon the head, insolation, the repercussion of a cu- 
taneous eruption, the sympathy of the cerebral organs 
brought into play by a gastritis or other visceral inflam- 
mation. Certain climates, and perhaps certain hereditary 
organic predispositions, favour its development; and to 
cite but one example, this disease is infinitely more com- 
mon in Geneva than in Paris. Great energy, and a too 
rapid growth of the cerebral organs, are certainly predis- 
posing causes of it 

Children from one to ten years of age, among whom 
inflammations of the cerebral substance are extremely 
rare, are, on the contrary, more subject than adults to 
those of the meninges; however, the latter are not exempt 
from it. 

Prognosis. 
Always very unfavourable; after the first period the se- 
rous effusion occurs, and there scarcely remains any hope. 



242 THE PHYSIOLOGICAL 

This disease seldom passes to the chronic state, yet there 
are some examples of this termination; a head-ache, more 
or less continued, accompanied with somnolency, convul- 
sive movements, and an impaired state of the intellectual 
faculties, are the most ordinary signs of it: the symptoms 
are the same when meningitis is primitively slow in its 
progress without succeeding the acute state. 

Treatment. 
It is important to act with promptitude, and upon the 
appearance of the first symptoms; if this be not done, 
every mode of treatment will be superfluous. Without 
dwelling upon the idea of dropsy, which does not yet ex- 
ist, but which the inflammation is about to determine, we 
must employ blood-letting much more boldly than it has 
heretofore been practiced ; for if the treatment of this for- 
midable malady is so generally observed to be unsuccess- 
ful, it is because the inflammation advances with rapidity, 
while time is lost at the beginning, in administering calo- 
mel, or other medicines, the least objection to which is 
their inutility, and it is determined at last to bleed, when 
depletion can no longer have any effect, except to increase 
the convulsions, and hasten the fatal termination. We 
must with haste apply a great number of leeches to the 
temples, over the course of the jugular veins, to the anus, 
along the spine; this operation must be preceded by gene- 
ral blood-letting; if the infant is large and strong, we re- 
peat the application, until the cerebral phenomena have 
been dissipated. The head should be covered with com- 
presses, wetted with cold water, and often renewed, 
while the thoracic and abdominal extremities should be 
kept hot by compresses, wet with water, rendered slightly 
stimulating with mustard, but they should not be irritated 
by strong sinapisms; this irritation almost always reacting 
upon the brain in infants. Frequent affusions of cold or 



PRACTICE OP MEDICINE. 243 

iced water, continued during many hours, may be substi- 
tuted for the cold compresses. The bowels are to be 
kept in a soluble state by mild laxatives, such as calomel, 
or by lavements. If this treatment be fully pursued, we 
shall often arrest the disease in its first period; but if it 
have reached an advanced epoch of the second stage, and 
with still greater reason, if it has reached the third stage, 
we must renounce this treatment, and confine ourselves 
to the administration of some cooling drinks. Having 
been placed in a situation where we had an opportunity 
to observe many patients affected with acute arachnitis, 
we have never known good effects produced either by 
blisters upon the head, or by setons in the back of the 
neck, by sinapisms, or by antispasmodics administered at 
the close of the second period, and during the third; and 
therefore why aggravate by these painful means the suf- 
ferings of the patient? The trepan, which has been ad- 
vised, and even tried, with the view of evacuating the 
fluids, is an absurd mode of treatment; an instantaneous 
death is always the result. 

CONTINUATION OP THE APPECTIONS OF THE NERVOUS 
CENTRES. 

(myelitis and spinal arachnitis.) 

We proceed to describe inflammation of the nervous 
substance of the spinal marrow conjointly with that 
of its envelopes. The first bears the name of myelitis, 
and the second that of spinal or rachidian arachnitis: it is 
acute or chronic. 

Symptoms. 
The symptoms of these two affections are easily con- 
founded, as those of encephalitis ;ir<: often confounded with 
those of meningitis. They may exis< simultaneously, or 
separately. 



244 THE PHYSIOLOGICAL 

Acute state. Myelitis. — Pain acute and profound, ac- 
companied with a sense of pungent heat along the spine, 
exasperated in a very marked manner by movement, some- 
times by decubitus on the back, but never by pressure. 
To this pain, which does not ordinarily exist, except in a 
part of the vertebral column, is added a state of stupor, 
accompanied with disagreeable formication in the abdo- 
minal members; this stupor is so much the more decided 
as the progress of the malady is more rapid; a paralysis, 
more or less complete, of the sphincters of the anus and 
bladder, manifested by the involuntary excretion of faecal 
matters and of the urine. Palsy supervenes in diverse man- 
ners; sometimes it pursues an ascending course; it gains, 
in succession, the superior part of the trunk, the superior 
members, the pectoral and intercostal muscles, and occa- 
sions the cessation of respiration, and death. At other 
times, but more rarely, palsy pursues an opposite course, 
and its progress is from above downwards; it may happen 
that palsy of motion and palsy of sensibility exist sepa- 
rately; these differences depend on the part of the spinal 
marrow which is the seat of the alteration. In some cases 
the limbs are at first affected with convulsions, which are 
afterward succeeded by paralysis; sometimes they exhibit 
a permanent painful contraction, or they are flabby and 
without any rigidity. It appears to be demonstrated that 
convulsions, and particularly permanent contraction of the 
limbs, are symptoms belonging more peculiarly to arach- 
nitis; flaccidity and paralysis to myelitis. To these acci- 
dents proper to myelitis, are sometimes added others less 
constant in their appearance; such are, at a very high de- 
gree of intensity, tetanic spasms, trismus, apoplexy, 
more or less difficulty of deglutition, aphonia, exalted 
sensibility of the sight and of the hearing; this last symp- 
tom evidently indicates a concomitance of cerebral irri- 
tation. 



PRACTICE 01* MEDICINE. 245 

We can ascertain with a certain degree of exactness, 
the seat of inflammation: if it is the superior region of 
the spinal marrow, situated near the annular protuberance, 
there is often furious delirium, trismus, difficult degluti- 
tion, paralysis of the whole body, and a rigid death; if it 
is the cervical portion, there is rapidity of movement in 
the muscles of the neck, convulsions, paralysis of the su- 
perior limbs, laborious respiration; if it is the dorsal por- 
tion between the two swellings of the spinal cord, there 
is, more particularly, convulsive and continued agitation 
of the trunk, in which the members do not participate, 
unless the structural change occupies a part of the swel- 
lings. When the lumbar portion, or rather the inferior 
swelling of the spinal marrow, is the seat of inflamma- 
tion, there is pain confined to the region of the loins, pa- 
ralysis of the sphincters of the rectum and bladder, as 
well as of the inferior extremities; sometimes there is 
satyriasis. 

Acute Spinal Arachnitis. — In most cases, the inflam- 
mation of the membranous envelopes of the spinal mar- 
row is propagated to that of the brain, or vice versd, so 
that the symptoms of cerebral and spinal arachnitis are 
found united. As we have considered the former in the 
section on encephalitis, we shall not return to it: the 
symptoms of spinal arachnitis, considered separately, are 
the same as those of myelitis; we observe in arachnitis, 
besides the violent pain along the spine, a general con- 
traction of the muscles of the posterior part of the body, 
which varies from simple muscular rigidity to the most 
violent contraction, determining retroversion of the head 
and trunk, as in tetanus. 

Causes. 
This inflammation is more frequently produced by the 
influence or external causes, by efforts, punctures, falls, 



246 THE PHYStOLOGICAL 

violent blows upon the spine, insolation during a hot season, 
alterations of the vertebras. It rarely arises from an in- 
ternal cause, yet it may be produced by the recession of 
a cutaneous eruption, by the extension of a neighbouring 
inflammation, particularly that of the brain, by the in- 
gestion of certain substances acting in a special manner 
upon the spinal marrow. Among the causes also are cited 
the suppression of the menses, of the haemorrhoids, of an 
issue, the metastasis of a muscular or arthritic inflammation. 

Prognosis. 

Most authors regard this phlegmasia as invariably mor- 
tal; yet examples of cure are cited. Its course is generally 
rapid; most frequently the fatal termination occurs from 
the tenth to the fifteenth day; in some cases from the third 
to the sixth. M. Ollivier reports a case which proves 
that this inflammation may be prolonged for the space of 
nearly thirty days. 

Chronic state. — When this affection is chronic, it does 
not generally occasion any sensations of a very painful 
kind; twitching of the muscles, palsy of the limbs, disor- 
der of the functions of the bladder and rectum, are the 
only symptoms that can lead to the suspicion of its exist- 
ence. These symptoms manifest themselves gradually; 
there is supineness and languor in the movements, a dis- 
position to inertness, from time to time a deep and dull 
pain in some point of the spine, pain along the course of 
the nerves which come from this point, intermission for a 
longer or shorter time of all these symptoms. 

Numerous organic alterations result from this disease. 
There is induration, 'ramollissement? or softening of the 
nervous substance, atrophy of the parts affected, and some- 
times of the whole body; caries of the vertebrae, purulent 
secretions, the production of abnormal tissues, &c. : whence 
it follows, that, in a very great number of cases, the dw- 



PRACTICE OF MEDICINE. 247 

ease is not in the spinal marrow, but in the neighbouring 
tissues, the cartilages of the vertebrae, and in the vertebrae 
themselves. This state may continue many years. 

Treatment. 
It is founded upon the same principles as that of other 
inflammatory affections. In the acute state we should, 
from the beginning, have recourse to abundant general 
blood-letting; afterwards apply a great number of leeches 
along the whole extent of the vertebral column, and prin- 
cipally upon the point corresponding to the seat of inflam- 
mation, cups may very well supply the place of the 
leeches, frequent warm baths, in which the patient should 
remain many hours, rigorous diet, cooling and emollient 
drinks taken in abundance, emollient lavements, mild 
purgatives, if there is no irritation of the digestive tube. 
Should we not resort to the prolonged application of ice 
along the whole extent of the spine, as in acute cerebral 
inflammations? After blood-letting, repeated with suffi- 
cient frequency, we may employ with success irritating 
local applications, such as the ammoniacal plaster, issues, 
setons, douches of warm water, and the most absolute 
rest. When the organic alterations are grave, and the 
pains become insupportable, we have no resources left 
but the employment of palliatives to calm them, such as 
the preparations of opium. 

IRRITATIONS OF THE NERVOUS EXPANSIONS. 
(neurosis and NEUKALUIA.) 

The diseases of the sensitive and locomotive nervous 
expansions, are at one time an inflammation of the nerves 
of locomotion and sensation, at another, a simple exalta- 
tion of their sensibility. 

Many of the neuroses of authors are, as we have seen 



248 TWE f*HY3IOi,OfcrlCAl. 

above, nothing but a phlegmasia of the encephalon and 
spinal marrow; such are apoplexy, catalepsy, mania, cho- 
rea, many species of paralysis, of tetanus, &c. But as 
these central irritations react upon remote parts, so do the 
irritations of the nervous branches react upon the centre, 
so that the essential matter in practice is to seize distinct- 
ly the point of departure. 

The large nervous trunks which are not remote from 
the skin, are often impressed through it: it is thus that 
cold produces the neuralgia called sciatica, as under other 
circumstances it produces pleurisy. 

Would the word neuralgia then indicate nothing to the 
practitioner, unless we attach some vague ideas to the 
pain, as is so frequently done in nervous affections? A 
nervous trunk suffers because it has been irritated or in- 
flamed under the influence of cold, a fall, a puncture, the 
incomplete section of a nervous branch, a contusion, 
the metastasis of another irritation, violent exercise, &c. 
A neuralgia is always something similar to the sciatica 
which has just been cited as an example: a neuralgia also 
is often caused by a nervous branch plunging into a focus 
of inflammation, into disorganized tissues, or by its being 
compressed by an osseous or other tumour, &c. 

Neuralgia may be divided into as many species as there 
are nervous branches; but these are always diseases of the 
same nature. It is upon these principles that authors 
have established the division of neuralgia into the facial, 
frontal, sub-orbitary, maxillary, dental, nasal, cubito- 
digital, sciatic or femero-popliteal, femero-praetibial, ileo- 
scrotal, plantar, &c. 

The mentioning of the names of these maladies is suf- 
ficient to point out their seats. 

Symptoms. 
Neuralgia manifests itself by acute pain, lacerating or 



PRACTICE OF MEDICINE. 249 

lancinating, following the course of the nervous branches, 
without tension or swelling of the affected part. The 
neuralgic pain sometimes assumes the character of remis- 
sion, or of intermission; at other times it is continued; 
when it is violent, it may determine fever. We call those 
cases of neuralgia, vague, which run in succession over 
the nervous trunks. The prognosis of neuralgia is dif- 
ficult to establish, on account of our often finding it im- 
possible to ascertain its causes. Facial neuralgia pur- 
sues, in particular, a very variable course: the duration 
of the attack is from some minutes to some hours; it 
sometimes resists all the therapeutic means with which we 
are acquainted. It may terminate in death after hav- 
ing lasted for a period of time varying in duration. Neu- 
ralgia, seated in the grand sciatic and in the crural 
nerves, may be acute or chronic, and last from some 
days" to months and years. We distinguish it from 
rheumatic pains by the fact that compression diminishes 
the pain, which is not the case in arthritic or muscular 
irritations. 

Treatment. 
If there is fever, or symptoms of irritation of the diges- 
tive passages, we commence with antiphlogistics, and pur- 
sue the ordinary treatment of the gastro-intestinal affec- 
tions; if the individual is strong and plethoric, we always 
commence with a general bleeding, and then resort to to- 
pical depiction, by means of leeches or cups. Among the 
other means employed hitherto against the neuralgic af- 
fections, some are empirical, others rational: the empirical, 
which are not on this account to be neglected, are the an- 
tispasmodics, and some other substances, such as opium, 
camphor, ether, assafcetida, the oxide of bismuth, prussic 
acid, belladonna, stramonium, the carbonate of iron, 



250 THE PHYSIOLOGICAL 

mercurial frictions, and in the cases in which there is pe- 
riodicity, the sulphate of quinine; lotions, composed of a 
drachm of the extract of belladonna, dissolved in an ounce 
of water, have often dissipated in the course of two or 
three days facial neuralgias, against which all other reme- 
dies had been found unavailing. Belladonna seems to 
possess an elective action on the nerves of the fifth pair. 
Frictions, employed five or six times a day on the parts 
affected with neuralgic irritations,have often bedn crowned 
with success. The good effects of the oil of turpentine 
are also vaunted, but we have to apprehend an inflam- 
mation of the intestinal tube. Finally, there is an empi- 
rical mode of treatment, the efficacy of which appears in- 
contestible in many cases: we refer to acupuncture, and 
electro-puncture. The numerous examples of cure, in 
cases of sciatic, facial, and other neuralgias, reported by 
MM. Majendie, J. Cloquet, and Sarlandiere, cannot be 
called in question. 

The means which we call rational, because we- can ex- 
plain their action, are revulsives, and principally burning 
by means of the moxa, or incandescent iron, also irritat- 
ing frictions, blisters, and cups. Sciatic neuralgia has often 
yielded to douches of hot water or vapour. No doubt 
but the same effect might be obtained by its application 
over the course of other nerves affected with this malady. 
Before we resort to the employment of revulsives and 
antispasmodics, we should always calm the irritation by 
the antiphlogistic treatment; experience and theory agree 
in the fact of its being much more easy to remove it 
afterwards. 

If neuralgia depends on the incomplete section of a 
nervous branch, we complete this section, and resort to 
the appropriate operations in other cases that require sur- 
gical means. 



PRACTICE OP MEDICINE. 251 



Pain and permanent contraction of all, or of nearly all, 
the muscles, and more particularly of those of the trunk. 

Symptoms. 
This malady makes its appearance suddenly, or comes 
on gradually. It is. often preceded by trismus, that is, by 
convulsions of the muscles of the jaws, with acute pain 
in this part; pain in swallowing; afterwards contractions 
of the muscles of the trunk supervene. If all these mus- 
cles are convulsed, the trunk remains straight; if the ex- 
tensor muscles alone are contracted, the spine and head 
are drawn backwards; this constitutes opisthotonos; if 
the flexor muscles are affected alone, the trunk is bent 
forwards, constituting emprosthotonos. Most frequently 
the muscles of the extremities participate in the con- 
traction of those of the trunk. The contraction does 
not present any alternation of relaxation, hence the name 
of tetanic rigidity, (roideur tetanique,) which has been 
given to it. These symptoms, truly pathognomonic 
of tetanic convulsions, are accompanied by other acci- 
dents more or less constant, such as subsultus tendi- 
num, violent fits of convulsion, pain, acute, atrocious, 
eliciting piercing cries, sleeplessness, delirium, aphonia, 
difficulty of respiration, fixity of look, suffusion of the 
eyes. Tetanus has been divided into the complete and 
incomplete, into the perfect and imperfect; but these di- 
visions are useless, and indicate only more or less violent 
degrees of the malady, or that it affects the whole or only 
some parts of the muscular system. Trismus, for exam- 
ple, is a true partial tetanus. 

Causes. 
We have seen that irritations of the brain and spinal 



252 THE PHYSIOLOGICAL 

marrow, as well as those of the membranes which enve- 
lope them, may produce clonic convulsions and para- 
lysis; they may also give rise to tonic convulsions, that 
is, to tetanus. The irritation of the meninges determines 
particularly convulsions of the latter species, and we 
know that spinal arachnitis gives rise to phenomena com- 
pletely similar to those of tetanus. Cerebral irritations 
may convulse all the muscles; those of the spinal marrow 
only convulse those which correspond to the part irritated. 
Irritation of the nervous centres, therefore, of the brain, 
and particularly of the spinal marrow, constitutes the first 
point of departure, and consequently all the causes of these 
irritations may be the causes of tetanus. (See Encephali- 
tis; see also Myelitis and Spinal Arachnitis.) Excessive 
heat and cold are very common causes of it. It is remark- 
ed that it often attacks new-born infants in equatorial re- 
gions, where the temperature is very elevated, and in the 
regions of the north where they plunge them into freezing 
water. Another point of departure is the irritation of a 
nervous branch remote from the centres; it is thus that 
punctures, lacerations, incomplete divisions, contusions, 
or compressions of one or more nervous branches, are 
often the causes of tetanus; a pin, a needle, a splinter, or 
any other body driven into the finger, determine some- 
times accidents entirely local, sometimes a neuralgia more 
or less limited, and sometimes tetanic convulsions. Large 
gunshot wounds being almost universally accompanied 
with contusions, comminutive fractures, splinters of bone, 
which irritate the nerves, not unfrequently give rise to it. 
In all these cases we denominate it traumatic tetanus. In- 
testinal worms and pains of the teeth may produce it, par- 
ticularly in infants; I have now under my care a case 
of tetanus produced by the sting of a bee; it cannot be 
doubted that certain substances introduced into tbe eco- 
nomy, and having an elective action on the spinal marrow, 



PRACTICE OF MEDICINE. 253 

the cerebellum, or the cerebrum, sometimes determine 
this disease. 

We may then establish it as a general rule, that tetanus 
depends always on an irritation having its primitive seat 
in the extremities, or in the centres of the nervous sys- 
tem. How can an affection of the nervous extremities re- 
peat itself on the centres in such a manner as to place them 
in the same pathological state as though they had primi- 
tively received the irritation? This is a question, the dis- 
cussion of which cannot find a place here; suffice it to 
know, that many other affections follow this double march 
in their development; to cite but one example, we know 
that epilepsy depends sometimes on a primitive irritation 
of the brain, at other times upon a cause existing at a dis- 
tance, as the compression of a nervous filament, the' point 
of departure of the aura epileptics. But it often happens 
that the nervous centres at last keep permanently the ir- 
ritation which they have received from the extremities, 
and that from the secondary having become the principal 
seats of irritation, a cure cannot always be effected by 
causing the cessation of the primitive irritation. Simple 
stimulation or sur-excitation, without being elevated to 
the degree of inflammation, may produce tetanus, and then 
it leaves no traces in the organs in which it is seated; at 
other times, and more frequently, there is a true phlo- 
gosis. 

Prognosis. 
It is always most grave. This disease proves fatal in 
the course of a few hours or days. In the unfrequent 
cases, in which it terminates in health, this event does 
not occur until after the lapse of fifteen or twenty days, 
sometimes at an earlier, and sometimes at a later period. 
In new-born infants it is promptly mortal. 
.33 



254 THE PHYSIOLOGICAL 

Treatment. 

Plans of treatment the most opposite have been tried, 
and abandoned in their turn, and have rarely been crown- 
ed with success: thus they have employed the antispas- 
modics, and particularly opium in high doses, internally 
and externally, ether, assafcetida, musk, castor, decoctions 
of canella and mint, fixed tonics, mercurial frictions, su- 
dorifics, purgatives, &c. These medicines should not be 
administered indiscriminately ; we should regard the na- 
ture of the causes. If then tetanus is connected with ir- 
ritation of the alimentary canal, we abstain from stimu- 
lants, and have recourse to blood-letting, the warm bath, 
&c. If it is owing to the presence of worms, we should 
cause their expulsion by suitable medicine, of more or 
less energy, according to the constitution of the patient 
and the state of the intestinal canal. 

The application of ice is one of the means that have 
most frequently succeeded. This application should ex- 
tend over the whole surface of the body. For this purpose 
we envelope the patient in a cloth wet with iced water, 
or, which is still better, containing pounded ice; we ad- 
minister at the same time a sudorific drink, such as the 
decoction of guaiacum, sarsaparilla, &c. with the precau- 
tion of not irritating too much the digestive tube. We 
then remove the ice for some minutes, and apply it again; 
we repeat this mode of proceeding several times in succes- 
sion. The object of this plan is to produce reaction, and 
to invite towards the skin the excess of vitality fixed on 
the nervous centres. 

If the tetanus arises from any mechanical lesion, we 
must, in the first place, remove this cause of irritation, 
without which all treatment will be unavailing. The em- 
ployment of general blood-letting, and the application of 
leeches along the spine, has been advised; but this means 



PRACTICE OF MEDICINE. 255 

is useless if the primitive seat of irritation exists in the 
nervous extremities, as is most frequently the case. Be- 
sides, there is not always a focus of irritation to calm; a 
simple sur-excitation may give rise to tetanic convulsions. 
But when the existence of an inflammatory focus is clearly 
demonstrated, blood-letting should be employed. 

In cases where there is no gastric irritation, might we 
not try the administration of tartar emetic in divided 
doses? Experience proves that this substance, thus admi- 
nistered, contributes powerfully to produce the cessation 
of the muscular contractions, and it certainly does not 
produce this effect by its revulsive action upon the sto- 
mach, for the same result is produced by cutaneous ab- 
sorption, and by injection into the veins. A number of 
observations prove the utility of this medicine associated 
with digitalis. The dose of each of these substances is 
from a sixth to a quarter of a grain every hour. 

Acupuncture and electricity have in every form been 
unsuccessfully tried. 

Cramp has some analogy with tetanus; it consists in the 
permanent contraction of one or more muscles, and gene- 
rally of those of the lower extremity; but this affection is 
usually of little importance, and is most frequently dissi- 
pated by placing the limbs in a suitable position, and by 
practising on them gentle frictions. 

CLONIC CONVULSIONS. 

We call those convulsions clonic, which exhibit an 
alternation of muscular relaxation and contraction. After 
all that has already been said, it is easy to conclude that 
convulsions depend, in the greater number of cases, upon 
an excitation, an irritation, or an inflammation of the ner- 
vous centres. But the point of departure is not always 
in the centres themselves. It is often in organs, in tis- 



256 THE PHYSIOLOGICAL 

sues, or in nervous branches, situated at a great distance- 
from these centres, the irritation, compression, or lacera- 
tion of which, acts upon the centres, stimulates them, ir- 
ritates them, and deranges their functions, whence result 
afterwards all the disorders of innervation. These dis- 
orders, viewed as a whole, should not be considered as 
an essential malady, but as external signs, indicating the 
state of the brain, of the spinal marrow, of a viscus, &c. ; 
in the same manner as the acceleration of the circulation, 
the heat of the skin, the abnormal redness of the tongue, 
thirst, in one word, all the phenomena which constitute 
fever, are not the disease, but the indices of a lo- 
cal inflammation, more frequently of the digestive pas- 
sages, but whose point of departure may be situated in 
many other parts of the body. In like manner convul- 
sions, periodical or continued, general or partial, with 
regular or irregular paroxysms, are the indices of a local 
affection of the nervous system, more frequently of its 
centres, or of any viscus whatever. It is thus, that when 
infants are seized with convulsions, this symptom arises 
sometimes directly from a cerebral or spinal irritation, as 
for example, in meningitis, (acute hydrocephalus of au- 
thors,) determined by insolation, a fall upon the head; and 
at other times from a remote irritation, as from dentition, 
from worms; in fact, in the case of infants and other per- 
sons whose nervous system is possessed of great mobility, 
this local irritation although remotely situated, repeats it- 
self with great facility upon the brain, which then acts in 
the same manner as when primitively affected. Further- 
more, the irritation which was only secondary, may, by 
its violence, its repetition, or its duration, determine a 
true, fixed inflammation of the centre, which at first was 
only irritated. Thus it is not uncommon for the pains of 
dentition to give rise to a true cerebral or cerebro-spinal 
arachnitis. The causes then of convulsions are all the or- 



PRACTICE OF MEDICINE. 257 

dinary causes of irritation, acting on the nervous system. 
Their seats are in the nervous centres or extremities, or 
in the organs with which these centres readily sympa- 
thize. The moral affections which exercise a direct in- 
fluence over the brain, may determine convulsions, with- 
out producing inflammation, and by cerebral excitation 
alone; but in the end, that which was at first only an ex- 
altation of vitality, may pass to a state of inflammation, of 
which we have many examples. The treatment of con- 
vulsions should therefore be based on a knowledge of the 
locality of the irritation, which gives rise to them; yet 
when there is no inflammation, or when, after having 
combated it, there remains a convulsive habitude, there 
are therapeutic means which may put an end to it, or 
prevent its return. We shall not describe here the nume- 
rous species of convulsive maladies pointed out by au- 
thors, first, because these affections are not here con- 
sidered in the same point of view in which they have for 
a long time been regarded; secondly, because to have de- 
scribed the cerebro-spinal maladies is at the same time to 
have spoken of the greater number of the nervous affec- 
tions. We will only enter upon a very few of the de- 
tails. 

CHOREA, OR ST. VITUs's DANCE. 

Irregular and involuntary gesticulations of the limbs, 
of one or of both sides of the body, a staggering gait, or 
rather a movement of the inferior extremities, resembling 
more or less that of a buffoon. We may arrest the 
gesticulations by seizing the limbs of the affected side; 
those of the opposite side are then suddenly seized with 
similar convulsions, and if we endeavour to keep motion- 
less all the extremities, as well the superior as the infe- 
rior, the convulsions assail the thoracic muscles. We af- 
firm this as having witnessed it in two cases. Sometimes 



258 THE PHYSIOLOGICAL 

this state is accompanied by a species of imbecility, or 
with diminution of the intellectual faculties. 

Causes. 
It makes its attacks particularly at the age of puberty, 
and more frequently affects girls than boys: still no age 
is altogether exempt from it. The 'first cause of this 
neurosis is evidently a cerebral excitation, often deter^ 
mined by a moral influence, and particularly by fear. It 
is not long since the young girls of a commune were al- 
most all affected with chorea, terrified by the descriptions 
which certain missionaries gave of the torments of hell. 
This malady is readily propagated by imitation, so that 
the affection of a single individual is sufficient to cause its 
communication, like an epidemic, to those who witness 
the extraordinary movements: here still the cause of this 
propagation is nothing more than the moral influence upon 
the brain; moreover, this mode of the transmission of ner- 
vous affections is not confined to this species alone. We 
must likewise regard as causes of this affection, venereal 
excesses, intestinal worms, a chronic alteration of the 
brain. 

Treatment. 
First, to separate the patients from each other; to act 
upon their minds by creating impressions the reverse of 
those they have received. To call into action the powers 
of the will to prevent the return of the attack. It is to 
various moral impressions that we must attribute the cures 
operated in these cases, and so many others analogous to 
them, by amulets, prayers, exorcisms, animal magnetism, 
&c. The sulphate of quinine, given immediately after the 
paroxysm, has often produced happy results. We employ 
likewise the cold bath, muscular exercise, and sometimes 
the antispasmodics. 



PRACTICE OP MEDICINE. 259 



THE MUSCULAR TREMOURS OP GILDERS. 

Gilders, and other persons exposed to mercurial emana- 
tions, are liable to be attacked with various affections, 
among others, with convulsions which have the greatest 
resemblance to chorea. They have a vacillating gait, and 
move backward when they desire to move forwards, and 
vice versd; involuntary gesticulation of the arm; in one 
word, a removal of the muscular movements from under 
the influence of volition. 

Notwithstanding this resemblance of the phenomena, 
the treatment should not be the same in these two cases. 

After having removed the patients from all mercurial 
influence, we have recourse to sudorifics in high doses, if 
the digestive tube is sound, and we particularly employ 
the thermal sulphurous waters, as well internally as in 
the form of baths or douches; if there is constipation, we 
administer mild laxatives. This treatment is likewise 
useful in all the other cases, in which an excessive quan- 
tity of mercury has been introduced into the economy. 

HYSTERIA. 

Symptoms. 
We observe two orders of phenomena in the attack of 
hysteria. The one occurs in the viscera of the abdo- 
men, the other in the locomotive nerves. In the abdo- 
men, these phenomena have much analogy with those of 
hypochondriasis: thus there is the sensation of a ball that 
moves with more or less rapidity in the abdomen, and 
rises towards the chest and throat. This ball seems to 
compress the diaphragm, the heart, the lungs, and the 
throat, to such a degree as to cause the fear of suffocation. 
There is flatulence, eructation, hiccough, sighs, violent 



260 THE PHYSIOLOGICAL 

palpitation of the heart In some women the abdomen 
dilates and contracts, rises and falls with the rapidity of 
bellows. 

This tumultuous state of the abdominal viscera is pro- 
duced by disorders acting upon the centre of perception, 
whence result at first malaise and anguish, which keep 
the patient immoveable, and prevent her speaking; but in 
a short time the irritation is transmitted to the brain, and 
rises to such a degree, that the will loses its influence over 
the muscles, and the woman agitates herself convulsively 
in all directions, in the manner of epileptic patients. 
There is violent contortion in the limbs, twisting, flexion 
of the spine in diverse directions, tetanic rigidity, con- 
tortions of the face, convulsive movements, rolling of the 
eye, and various other extraordinary motions. In some 
cases the nervous disorders of the abdominal viscera, in- 
stead of provoking convulsions, produce a cessation more 
or less complete of the functions of the brain and other 
organs. The woman remains motionless, loses the use of 
her senses, respiration is suspended, and the circulation of 
the blood is almost imperceptible: sometimes even life 
appears to be perfectly extinct. 

It happens frequently, that attacks of hysteria termi- 
nate by cries, by weeping, by fits of immoderate laughing, 
by an abundant flow of limpid urine, by the excretion of 
mucosities from the vagina; sometimes a flow of urine 
precedes and terminates the attack. 

Causes. 
The occasional cause is an irritation of the uterus, but 
this irritation does not produce all these sympathetic pheno- 
mena, except in women endowed with great irritability, and 
whose constitution is on that account called nervous; in a 
woman of little irritability, the uterus may be irritated or 
inflamed without giving rise to hysteria; the signs of the 



PRACTICE OP MEDICINE. 261 

uterine affection are limited to local suffering, and some 
kind of discharge. Every time, on the contrary, that the 
genital apparatus suffers in the first, the other organs par- 
take of the affection; it is not necessary, to produce this 
effect, that there should be a real inflammation; the san- 
guineous congestion that precedes the menstrual flux, the 
abuse of venereal pleasures, or extreme continence, every 
species of unusual orgasm, may irritate the uterus to the 
point in which it reacts upon the other viscera, through the 
intermediacy of the grand sympathetic, and on the brain, 
and thus determines an attack. But as the irritation of 
the uterus involves the other viscera in derangement, so 
the irritation of these viscera excites the vitality of the 
uterus and occasions attacks. Chronic gastro-enteritis, 
indigestion, and irritations of the chest, are then, in women 
who are predisposed, causes of hysteria. Moreover, 
though the point of departure be the uterus, which dis- 
turbs the cerebral functions, yet when women have con- 
tracted the habit of these attacks, all excitations acting 
immediately on the brain may produce them; the brain 
then excites the uterus, which reacts, and the same phe- 
nomena are produced. It is thus that strong moral affec- 
tions, certain odours, the sight of a disagreeable object, 
occasion hysterical attacks. 

Indolence and luxury predispose to hysteria, as also to 
most of the nervous maladies, for, the muscles not being 
exercised, vitality remains in excess in the nervous system. 

The attack may last from a few minutes to some hours. 

In hysterical women, menstruation is ordinarily de- 
ranged, suppressed, or diminished, rarely augmented, of- 
ten irregular. 

Prognosis. 
We must not forget that uterine irritation is most fre- 
quently accompanied with that of the digestive organs, 
34 



262 THE PHYSIOLOGICAL 

that it may have altered the tissues of the womb, and that 
the danger is in proportion to the gravity of these affec- 
tions; but in general hysteria terminates after some years 
of duration, or towards the critical age; at other times, on 
the contrary, it makes its first appearance at this period 
of life. It is not uncommon for it to lead to mania and 
epilepsy. 

Treatment. 

As in the majority of cases, there is a concomitance of 
uterine and gastro-enteric irritation, the treatment should 
be the same as that of chronic gastritis. If the uterine ir- 
ritation is of a certain degree of acuteness, we combat it 
with local bleeding, lavements, baths, refrigerant drinks, 
abstinence from stimulating aliments; but if there is only 
simple sur-excitation, or exaltation of sensibility, we should 
be sparing of blood-letting, which might debilitate the pa- 
tient and render her more sensible to the impression of 
the causes that determine the attacks. The irritation be- 
ing appeased by the emollient regimen, the convulsive ha- 
bit is to be attacked by antispasmodics, such as assafoetida, 
opium, valerian, ether, &c. The Peruvian bark has some- 
times succeeded, especially when the disease has exhibited 
the character of periodicity. 

We must be particular in prescribing muscular exercise 
in the open air, agricultural occupation, travelling, gym- 
nastic exercises, &c. ; these exercises have the double ef- 
fect of preventing the cerebral reflexion of the sensations 
which the viscera experience, and of throwing upon the 
muscular apparatus, the surplus of vitality which torments 
the nervous system. Coition is only beneficial, when the 
irritability of the uterus arises from continence ; if, on the 
contrary, this irritability is the effect of excessive indul- 
gence, as often happens, the patient must use venery but 
very seldom, and in some cases abstain altogether. We 



PRACTICE OF MEDICINE. 263 

should not always provoke by emmenagogues the return 
of the menses, whose suppression depends upon irritation 
fixed either upon the womb or upon some other part. We 
must then first of all allay this irritation. (See Amenor- 
rhcea.) 

If we are only occupied with the prevention of the at- 
tack, and if its approach be announced by prelusive signs, 
we often succeed by using friction over all the limbs, by 
affusions of cold water upon the face, by the application of 
a ligature between the point of departure and the brain, 
if we can ascertain it, as in epilepsy; the woman can 
sometimes prevent an attack by the sole influence of the 
will. During the attack we place the patient in the ho- 
rizontal position, and admit the fresh air; we loosen the 
parts of the dress which may bind her, and we must take 
care that she does not injure herself; affusions of cold wa- 
ter, friction, antispasmodic lavements, and especially those 
of assafcetida, are often employed with advantage to break 
up the attack, when it is very violent or protracted. It is 
not always prudent to make the patient inhale strong 
odours, as many women are greatly incommoded by them; 
with regard to this point, we must consult the habits of 
the individual. 

HYPOCHONDRIASIS. 

This affection, which some authors have recently styled 
gastro-enteralgia, is nothing but a chronic gastro-enteritis 
in a nervous and irritable subject. (See Chronic Gastro- 
enteritis.) 



264 THE PHYSIOLOGICAL 



NEUROSES OF THE ORGANS OF RESPIRATION- 

CONVUiSIVE ASTHHA. 

Symptoms. 
The attack of asthma generally comes on during the 
night, by a sudden sense of constriction of the chest, by a 
wheezing respiration, so painful that it compels the pa- 
tient to assume the erect posture. There is violent and 
convulsive cough, and considerable oppression, which 
renders speaking difficult, and causes its interruption by 
the want of respiration. Towards the end of the paroxysm, 
which ordinarily occurs at daybreak, the cough abates, the 
dyspnoea diminishes, the patient expectorates a great quan- 
tity of mucosities, all the symptoms are remarkably ame- 
liorated, and even disappear more or less completely, un- 
til the following night, when the attack is renewed. The 
pulse is sometimes accelerated, weak, small, at other times 
large and strong, according to the cause of the disease and 
the constitution of the patient. The attack is not always 
sudden; in some cases it is preceded by lassitude, torpor, 
somnolency, borborygmus, pains of the head. 

Causes. 
Asthma may be determined by an organic affection of 
the lungs or of the heart, by a chronic irritation of the 
bronchial mucous membrane, by a chronic gastritis. As 
the attacks return periodically, the existence of organic 
affections as the causes of asthma have been denied: but 
in most of the other intermittent affections, we meet with 
permanent irritation of an organ. This permanent irrita- 
tion is exasperated, or it determines by degrees an afflux 
towards the lungs; this produces the sense of anxiety, and 
the want to respire, which provokes violent contractions 



PRACTICE OF MEDICINE. „ 265 

of the thoracic muscles, continuing until the organs of re- 
spiration find themselves freed either from this exacerba- 
tion of irritation or from the sanguineous congestion which 
it may have determined. This state terminating, the re- 
spiration becomes more calm, until at the end of a period 
varying from eighteen to twenty-four hours, the same 
phenomena again make their appearance. Thus, to speak 
properly, there is no asthma purely nervous, except that 
produced by moral causes, and in this case even, it often 
depends upon a bronchial, pulmonary, gastric, or cardiac 
irritation, awakened by this moral influence. The return 
of the exacerbation at fixed epochs, has nothing in it 
which should astonish us; sleep, the sense of hunger, the 
alvine dejections, the menstrual evacuation, &c. also occur 
at determined epochs. 

A great number of occasional causes may produce 
asthma in subjects who are predisposed, and in the nerv- 
ous and the irritable. Thus humidity, cold, sudden at- 
mospheric vicissitudes, plethora, every thing that throws 
the blood upon the lungs, as running, the return of cer- 
tain seasons, the suppression of an habitual evacuation, of 
an issue, the repression of a cutaneous eruption, the me- 
tastasis of an arthritic or muscular irritation, &c. may oc- 
casion it. Hydro-pleuritis and pulmonary tubercles are 
often the cause of asthma: the former, by the obstacle 
which it presents to the circulation, and the latter by the 
irritation which they keep up in the parenchyma of the 
lungs. 

Prognosis. 
If the irritation is slight, and especially if the subject is 
young, it is easily displaced; it often terminates in pulmo- 
nary consumption or in hydrothorax: a very short respi- 
ration, and paralysis of the arms, arc fatal symptoms. 



266 THE PHYSIOLOGICAL 

Treatment- 

It has been observed that asthma often ceases upon the 
appearance of another irritation, which supervenes spon- 
taneously, for example, an eruption or a hemorrhage. 
The observation of this fact should serve as a guide to the 
practitioner. The most efficacious means of removing the 
attack of asthma, and of obtaining a radical cure of the ir- 
ritation which gives rise to this malady, is blood-letting, 
frequently repeated. General blood-letting should be pre- 
ferred if the malady depends upon an affection of the 
heart, and topical, if it depends upon an irritation of the 
bronchia, trachea, or larynx. After blood-letting, we em- 
ploy revulsives, such as a blister upon the chest, a perma- 
nent issue on the arm. If asthma depends on the dis- 
placement of an arthritic or rheumatic irritation, we should 
endeavour to recal this irritation to its primitive seat. 
The same principle is applicable in case of the suppres- 
sion of an issue, of a haemorrhage, or any other evacua- 
tion. 

When the irritation has been allayed or destroyed by a 
prolonged employment of this treatment, the convulsive 
habit, if it persists, may be combated by antispasmodics ; 
if there exist no gastro-intestinal affection, opium, hyos- 
cyamus, lactuca virosa, assafcetida, ether, and the sulphate 
of quinine, have often been employed with success. Of 
late the employment of electricity has also been highly ex- 
tolled. To prevent the return of the attacks, the patient 
must avoid all the occasional causes. 

INCUBUS, OR NIGHTMARE. 



This is a shade of asthma. If we suppose the dysp- 
noea which precedes asthma to disappear on waking, we 
have an idea of incubus. Persons subject to this disease 



PRACTICE OP MEPICINE. 267 

experience a sense of compression and of constriction of the 
chest, which appears to them to be produced by the pres- 
sure of a weight, as that of a cat, a bundle, &c. The 
causes are the same as those of asthma, that is, most fre- 
quently an irritation, chronic or otherwise, of the organs 
of respiration, or of the heart. 

The treatment should consequently be the same as that 
of asthma. It is expedient for the patients to abstain from 
eating in the evening, and, if the phenomenon often oc- 
curs, it is necessary for some one to sleep near them, for 
the purpose of waking them. 

NEUROSES OF THE HEART. 

PALPITATION. 

The symptoms of this affection consist of pulsations, 
stronger, more rapid, and less regular than in the normal 
condition. 

Causes. 

In the greater number of cases palpitation depends 
upon an organic affection of the heart, or of the great ar- 
terial trunks, or of the lungs. In these cases we should 
investigate the precise seat and nature of these organic 
lesions, of which the palpitation is only a symptom. It 
may likewise be produced without the existence of any 
organic alteration, and solely by an excessive irritability 
of the heart, brought into play by the occasional causes 
which act upon this organ; such are strung moral affec- 
tions, the acceleration of the course of the blood, occa- 
sioned by rapid walking, or in any other manner, venereal 
excitement, disagreeable odours, &c. 

It is to be remarked that individuals who arc thin, con- 
valescent, exsanguious, or of a feeble constitution, mom 
readil) experience palpitations than those who enjoy a 



268 THE PHYSIOLOGICAL 

sanguine, robust, and vigorous constitution; the latter, 
in fact, offer more resistance than the former to the im- 
pression of the occasional causes. Pains of the viscera, 
even without inflammation, the influence of the genital 
organs, a gastric or other irritation, the transfer of an irri- 
tation, as for example, the muscular or arthritic to the 
heart, may give rise to palpitation. We may consider it 
as nervous when it depends solely upon an excess of irri- 
tability, but it is by no means of this character, when it 
depends upon an organic irritation or alteration; for a car- 
ditis, a pericarditis, a hypertrophy of the heart, an ossifi- 
cation of the great arterial trunks or of the valves of the 
heart, pulmonary tubercles, a hydro-pleurisy, &c. all 
causes capable of occasioning palpitation, are certainly not 
neuroses. The line of demarcation between palpitation 
which depends upon an excess of sensibility, and that 
which depends upon an alteration either of the heart or 
of the other organs, is not always easily determined; yet 
when it occurs but rarely, it is probable that it is only 
nervous. We must never forget that these palpitations 
occur under the influence of a temporary excitation, and 
that this excitation, in consequence of its repetition, may 
become a permanent irritation, then an acute or chronic 
inflammation, which cannot long affect a tissue without 
altering its structure. 

Treatment. 
When palpitations are but a symptom of an affection, 
either of the heart itself, or of the organs of respiration, 
or at least but an index of the commencement of irritation 
in these different organs, it is not against the palpitation 
that the treatment must be directed, but against the affec- 
tion which is the cause of it. If there is plethora or a dis- 
position to hypertrophy of the heart, we have recourse to 
blood-letting, and to a mild regimen, containing but little 



PRACTICE OP MEDICINE. 269 

nourishment. We try to recall suppressed evacuations, or 
we supply their place by blood-letting; we employ revul- 
sion towards the extremities, if the malady depends on a 
transfer of an arthritic or muscular irritation. As to pal- 
pitations called nervous, and which depend on a great mo- 
bility either of the heart or of the nervous system, we must 
employ the same means if the subject is strong and ple- 
thoric; if he is weak and feeble, the abstraction of blood 
will only augment the disposition to palpitation. In this 
case we endeavour to strengthen the constitution with 
food which is substantial, without being of a heating nature, 
by a residence in the country where the air is pure and free, 
and by moderate muscular exercise. We employ likewise 
the fixed tonics. Should we administer the digitalis pur- 
purea? It is almost always of manifest utility, if the sto- 
mach is not in a state of irritation. It is in fact a power- 
ful sedative to the movements of the heart, which we must 
not overlook; but we should not employ it under the form 
of the alcoholic tincture, as is often done. This combina- 
tion of a diffusible stimulant with a sedative substance, is 
absurd. 

If the movements of the heart, instead of being accele- 
rated, are suspended, as occurs in syncope, produced by 
blood-letting, we must employ stimulants internally and 
externally, dry friction, and especially affusions of cold 
water upon the face and chest. 

ANGINA PECTORIS. 

In this complaint persons are seized suddenly, and of- 
ten during walking, with an acute pain and a sense of con- 
striction, which seems to draw together the sternum and 
vertebral column; suffocation is threatened; the patient is 
in fear of death, and is forcibly arrested in the midst of his 
progress. The attacks, at first slight, at distant periods, 
and of short duration, become progressively more violent. 
35 



270 THE PHYSIOLOGICAL 

longer, and more frequent; they occur when the patient 
goes to bed, when he places himself in the horizontal po- 
sition; the facility with which they are brought on be- 
comes greater and greater, and they are renewed under 
the influence of the slightest causes. In some cases the 
pain does not occupy the chest exclusively, but extends 
to the superior members, whose movements it embar- 
rasses, to the lower jaw, to the ear, to the diaphragm, or 
to the epigastrium. The duration of the malady, and of 
its attacks, and the time of their return, present no re- 
gularity. 

Causes. 

Asthma, palpitation of the heart, and angina pectoris, 
are maladies which are all attributable to common causes; 
these causes are obstacles to the circulation of the blood, 
which depend upon lesions of the lungs, of the heart, or 
of the great arterial trunks. In individuals who fall vic- 
tims to these affections, we constantly find diverse organic 
alterations, according to the seat, the duration, and the 
degree of the irritation: we meet with dilatations and hy- 
pertrophy of the heart, ossification of its valves, as well 
as of the great arterial trunks, traces of chronic pericar- 
ditis, tubercles, and other alterations of the lungs, scirrhus 
of the stomach, &c. The attributing of this affection, as 
has been clone by Jurine, to a lesion of the pulmonary and 
cardiac nerves, is a pure supposition, disproved by dis- 
section. 

The occasional causes which determine an attack when 
there exists a predisposition, are the same as those of 
asthma and palpitation of the heart, (see these articles.) 

It results from these observations on the etiology of 
angina pectoris, that this is not an essential malady, that 
it is not even a nervous malady, but simply a form of ir- 
ritation of the lungs or of the heart. 



PRACTICE OF MEDICINE. 271 

Prognosis. 

This disease is very serious, particularly if it has been 
oflong duration; it may terminate by a sudden death. If 
it is combated from its first attack, there may be some 
hope of arresting the progress of disorganization. 

Treatment. 

If the pulsations of the heart are strong, and the subject 
vigorous, the abundant abstraction of blood is necessary; 
in opposite cases it would be injurious. In all cases, rest 
or gentle exercise, emollient drinks, vegetable regimen, 
abstinence from vcncry, revulsives, such as cups, blisters, 
irritating frictions upon the sternum and between the 
shoulders, the recalling of suppressed evacuations to their 
primitive seats, or the supplying of their place by blood- 
letting. The same principle must regulate our treatment 
in gout or any other phlegmasia which has been repelled. 
To recall an affection of what kind soever to its primitive 
seat, we must calm the consecutive irritation, and stimu- 
late the part which was primitively diseased. We should 
remember, in relation to this, that the facility with which 
an irritation is displaced, is in the inverse ratio of its in- 
tensity, and that irritation has a greater tendency to re- 
appear in a part in which it has already existed. 

Digitalis purpurea should not be overlooked as a means 
of reducing the pulsations of the heart. 

We succeed sometimes in removing or in moderating 
an attack, by the administration of antispasmodics, when 
the digestive tube is sound. 

II. is unnecessary to remark, that to prevent a return of 
the attack, the patient must be guarded against the influ- 
ence of the occasional causes. 

The exhibition of emetics, as advised by Jurinc in this 
affection, is attended with extreme danger, on account of 



272 THE PHYSIOLOGICAL 

their increasing the sanguineous congestion about the 
lungs and heart. The employment of phosphorated le- 
monade, as some authors recommend, to prevent ossifica- 
tion of the arteries, is absurd. 

HYPERTROPHY AND ANEURISM OF THE HEART. 

Hypertrophy of the heart, which Corvisart denominates 
active aneurism, is announced in persons who are inclined 
to it, by the following signs: at first, there is tendency to 
suffocation, acceleration of the circulation of the blood, 
strong pulsations of the arteries; these persons are lively, 
irascible, their face is red, their extremities are warm, so 
that they do not fear cold ; they are subject to frequent and 
abundant haemorrhages, by which they find themselves 
benefited; their constitution is generally robust and vigor- 
ous, and all the functions are performed sufficiently well; 
what incommodes them most, is violent locomotion, or a 
collection of many persons in one place. 

This disposition is always progressive, so that we trace 
the malady from the first degree of hypertrophy, to 
aneurism, properly so called. On the occasion of cold, 
heat, or of a passion, hypertrophied subjects are attacked 
with pulsations of the heart so violent, that patients com- 
pare them to the blows of a stick; the pulse is then hard 
and vibrating; there is the fades vultuosa, and the eyes 
are injected. It is then said that it is an attack of asthma. 
The first attacks of this kind continue ten, twenty, thirty, 
or forty hours; but as the disease advances, the dyspnoea 
endures a greater length of time; at last there comes the 
state that is named angina pectoris; there is pain in the 
left shoulder, in the arm, &c. It is not essential to the 
existence of hypertrophy that dyspnoea be continual, as 
some authors pretend; for organic affections of the heart 
always commence with a slight transitory dyspnoea. We 



PRACTICE OF MEDICINE. 273 

know that the disease is not connected with the orifices 
of the heart, when the pulsations correspond in time and 
force with those of the arteries; in other cases, that is, 
when there is irregularity, the obstacle is more frequently 
at the orifices of the heart. 

If the patients are calm and cautious, and preserve a 
state of rest, they may live for a very considerable length 
of time; but if they expose themselves to the action of the 
occasional causes, they may die of an attack of dyspnoea, 
or angina pectoris. Some patients expectorate a great 
deal, others experience attacks of coughing without being 
able to expectorate. At last there arrives a period, when 
the pulse, from having been hard and vibrating in the be- 
ginning, and during the greater part of the progress of the 
malady, becomes small, soft, and weak; by the cylinder 
applied to the chest, or even by the simple touch, we per- 
ceive a large heart which moves with difficulty, and 
whose pulsations are weak, slow, and unfrequent. This 
is aneurism properly so called, which authors have named 
passive aneurism. 

There are besides, various other symptoms, that show 
to a certain point whether the affection is seated in the 
right or left cavities of the heart, but this precision of 
diagnosis is of little avail in practice; it is thought that 
the seat is in the left cavity when the pulsations are strong 
and vibrating, and that the disease occupies the right 
cavity when the integuments are of a violet colour, or 
blackish, and pulmonary haemorrhages are frequent; but 
this diagnosis is any thing but certain. 

On dissection wc find different lesions. Death is rarely 
occasioned by pure and simple hypertrophy, unless the 
patient has been badly treated, or has had pulmonary con- 
gestion, attacks of apoplexy, or a complication of gastritis: 
we may find hypertrophy of the two sides of the heart; 
at other times, there is contraction of one side, and en- 



274 THE PHYSIOLOGICAL 

largemenfof the other; in certain cases, the walls of the 
left ventricle are attenuated and dilated, in other cases 
they are thickened. We sometimes meet with laceration 
of the columna? carneae of the heart, sometimes the orifices 
are obstructed by concretions varying in hardness, re- 
sembling polypus, consistent, of a cartilaginous or osseous 
character; there is often thickening and induration of the 
valves. 

The internal membrane of the heart is sometimes red, 
there are ulcers at the base of the heart, its substance is 
hardened or softened, altered in its composition, friable; 
we often observe ossification of the great vessels in the 
neighbourhood of the heart, of the coronary arteries, &c. 
Clots of blood are sometimes organized and adherent to 
the internal walls of the heart, the cavities of which are 
then extremely contracted. 

Causes. 

There may be an innate predisposition; the occasional 
causes are the too frequent stimulation of the heart by 
violent exercises, strong passions, the action of heat or 
cold, venereal pleasures, the transfer of an irritation to 
the heart, as in the case of the suppression of an issue, a 
herpes, a haemorrhage, and particularly the metastasis of a 
muscular or arthritic irritation, food of too succulent a 
quality, the abuse of alcoholic drinks, the chronic phleg- 
masia?, and organic alterations of the lungs, ossification of 
the arteries. 

These different causes produce sometimes simple palpi- 
tation, a pericarditis, a pneumonia, a pleurisy, a catarrh, 
polypi of the heart; at other times hypertrophy and aneu- 
rism, according to the special irritability of the organs 
contained in the thoracic cavities. 



PRACTICE OF MEDICINE. 275 

Prognosis. 
As long as hypertrophy is but little advanced, we may 
obtain its cure by the treatment about to be indicated. The 
chances of success diminish in proportion to the progress 
it has made, and all hope is over when the disease has ar- 
rived at the stage which is called passive aneurism. Sub- 
jects affected with hypertrophy may be carried off by a 
pneumonia, a pulmonary or nasal haemorrhage, or an apo- 
plectic attack. The diverse alterations which the heart 
and its appendages undergo, often give rise to apoplexy, 
by the obstacles which they oppose to the circulation of the 
blood, but this phenomena does not supervene but when 
the disease is very far advanced. 

Treatment. 
Variable, according to the epoch of the affection. That 
of hypertrophy is rigorously antiphlogistic: thus blood- 
letting, abstinence, cold to the epigastrium, to the region 
of the heart, refrigerant drinks, the subjugation of the pas- 
sions: we advise every thing that prevents the acceleration 
of the blood, and every thing that retards sanguification ; 
consequently an absence of mental emotion of every kind, 
the avoidance of places which are too hot, or crowded, as 
assemblies; the ascent of stairs, cries, singing, playing upon 
wind-instruments, and prolonged watching, are to be 
avoided; the abandonment of laborious professions should 
be enjoined. We have recourse to the means proper to 
diminish the rapidity of the circulation, particularly to 
the digitalis purpurea in progressive doses from one to 
nine or ten grains and upwards, daily, to the acids taken 
in small quantity, and to drinks acidulated with the vege- 
table acids. In administering the digitalis, we must watch 
its action upon the alimentary canal, and diminish the dose 
or cease the employment of it, if it creates irritation 



276 THE PHYSIOLOGICAL 

there. Complete abstinence from coffee, tea, and spiri- 
tuous liquors. By these means we arrest for a long time 
the progress of hypertrophy, and if the patient is willing 
to submit to the method of Valsalva, we may hope for a 
radical cure. This method consists in the employment of 
copious blood-letting often repeated, in not giving to the 
patient for drink or for nourishment any thing but water 
with the yolk of an egg, and when he is very weak, in- 
creasing his strength gradually by light diet, progressively 
more nourishing. This treatment should be pursued during 
two or three months. 

The abstraction of blood must be more frequent in win- 
ter than in summer, because the blood being in this sea- 
son more strongly thrown upon the viscera, the danger 
increases. Catarrhs, which are also more frequent during 
this season, require leeches, rest, and a mild warmth ; 
when an attack of dyspncea occurs, we have immediate 
recourse to blood-letting. If there be obstinate cough with- 
out expectoration, we may give the squill or the kermes 
mineral, paying attention to the state of the digestive or- 
gans. 

When dropsy supervenes, there is still hope if there is 
only hypertrophy, if the obstacle to the circulation is not 
too considerable, and if the communication of the cavities 
of the heart with the arteries is free: we employ in the 
first place blood-letting, afterwards diuretics and purga- 
tives. The complications of pneumonia, of gastritis, and 
of apoplexy, require the treatment appropriate to these 
affections. (See these articles.) 

WHITE, OR LYMPHATIC IRRITATIONS. 

We have hitherto seen various organic alterations pro- 
duced by a preceding inflammation, which by causing an 
afflux of fluids to the inflamed tissues, gives rise to tuber- 



PRACTICE OP MEDICINE. 277 

cles, to white tumours of the articulations, to melanosis, 
to obstructions of the liver, to cancer of the stomach, of 
the womb, or of the bladder, &c. In these cases, it was al- 
ways inflammation which terminated in these forms of 
disease. We shall now consider these forms as primitive, 
and before all inflammation; that is to say, we shall now 
take up the consideration of scrofula, and of many other 
affections which are referred to it, such as rickets, maras- 
mus, goitre, &c. 

Physicians entertain very different opinions on the na- 
ture of scrofula; some attribute it to weakness, or to 
atony; others make it depend upon irritation, but upon an 
irritation which is slow, feeble, and below the inflamma- 
tory irritation, and on this account they give it the name 
of sub-inflammation. The doctrine of the latter is more 
conformable to the observation of facts and to reason. 

The objections which are raised against this doctrine 
are refuted without difficulty; they reduce themselves 
nearly to the following: 

First Objection. — Scrofulous affections are generally 
met with in weak subjects, and those possessed of little 
energy. But we must know whether the idea which per- 
sons generally attach to the words strength and weakness 
is one of great accuracy; the individual is weak, accord- 
ing to the common acceptation of the term, who has the 
muscular system little developed, and the nervous system 
endowed with great energy; hence we erroneously proceed 
to attribute to all the systems, what is only predicable of 
particular ones among them, especially as the different 
systems of the economy live in a state of mutual depen- 
dance, and in such a manner, that one of them does not 
often predominate but at the expense of the rest. 

Second Objection. — The lymphatic temperament is that 
which predisposes most to scrofula. This is true; but is 
there, in this temperament, weakness of the lymphatic 
36 



278 THE PHYSIOLOGICAL 

system as they think ? It is much more natural to attri- 
bute to an excess of vitality, the action by which this sys- 
tem absorbs, elaborates, and carries a greater quantity of 
the lymph. It is thus we say that there is energy of the 
sanguineous system, when all the parts are steeped in 
blood, and the apparatus of circulation is largely develop- 
ed. Why is not the same mode of reasoning applicable to 
the lymphatic system ? 

Third Objection. — The causes which determine the 
scrofulous constitution, or which occasion the develop- 
ment of scrofula, when this constitution is innate, are 
rather of a nature to debilitate than to excite. This re- 
mark is true, although a false conclusion is deduced from 
it; for, in the first place, under the influence of debilitat- 
ing causes, sueh as humidity, cold, obscurity, the absence 
of the solar light, bad nourishment, the want of exercise, 
the muscular, sanguineous, and nervous systems develope 
themselves but little, a circumstance which favours the 
predominance of the cellular and lymphatic over the 
other systems; secondly, when the scrofulous predis- 
position exists, the ordinary causes of irritation occasion 
the development of scrofula; in fact when, in a subject 
of a scrofulous constitution, an articulation happens to be 
the subject of external violence, a white tumour will there 
develope itself, while in other subjects nothing similar 
will take place: examples of this kind present themselves 
in great numbers. If in scrofulous subjects the irritating 
causes attack preferably the lymphatic system, it is be- 
cause these causes always tend to develope irritation in 
the tissues most disposed to contract it; thirdly, scrofulous 
diseases with regard to their seats, follow, in the different 
stages of life, the order of irritation in general; that is to 
say, we observe them in the parts of the body that enjoy 
the greatest share of vitality; thus in infancy we observe 
them on the head, in the lower belly, and on the external 



PRACTICE OF MEDICINE. 279 

parts of the body; we see in them tinea, an engorgement 
of the glands of the neck, of those of the mesentery; in 
youth the lungs are particularly attacked, and we meet 
with tubercular phthisis; in old age the articulations swell, 
the legs are ulcerated, &c; the lymphatic engorgements 
of the scrofulous lead to suppuration, as well as engorge- 
ments of a nature which all allow to be inflammatory. 

The small share of vitality possessed by the lymphatic 
system, accounts for the slow progress of the irritation. 

It is not debility then that is the immediate cause of 
scrofula; it may determine it for the reasons already men- 
tioned, but the scrofulous affection itself is not a debility; 
how are we to conceive of debility with pain, heat, and 
swelling? 

Fourth Objection. — The scrofulous predisposition and 
scrofula itself are cured by the employment of stimulants. 
This observation, in part true, only proves that under the 
influence of stimulants, such as good nourishment, insola- 
tion, exercise in the open air, and under a fine sky, the 
muscular, nervous, and sanguineous systems gain develop- 
ment and energy; whence the lymphatic system loses the 
predominance which it had over the systems, and the 
equilibrium is re-established. Is it not known, moreover, 
that local blood-letting favours powerfully the resolution 
of the lymphatic glands of the scrofulous? Do we not 
know likewise that stimulants, when they do not produce 
in the other systems the effects which we have just men- 
tioned, hasten the development of scrofula, because the 
excitation employed turns to the advantage of the super- 
abundant vitality of the cellular and lymphatic systems? 

Let us now enter upon the consideration of scrofula in 
particular, and of some of its varieties. 

Signs of the Scrofulous Constitution. — Individuals 
predisposed to scrofulous affections ordinarily present from 
infancy the following characteristics; the lymphatic tem- 



280 THE PHYSIOLOGICAL 

perament, a remarkable development of the cellular tis- 
sues, a swelling of the upper lip and of the nose, a dis- 
charge from the ears, a vitreous colour of the cornea, 
swelling and frequent irritations of the edges of the eye- 
lids, of the conjunctiva, of the mucous membrane of the 
nose, which is often covered with scabs, lips easily chap- 
ped under the influence of cold, a disposition to en- 
gorgements of the lymphatic glands on the slightest cause, 
voluminous articulations, deviation of the bones of the 
limbs, of those of the thorax and vertebral column, (ra- 
chitis^) a disposition to caries of the teeth and bones, fair 
and soft skin. 

Scrofula may, however, exist in persons of a dark 
complexion. Children predisposed to the disease are ge- 
nerally beautiful, lively, and of precocious intelligence. 
Tabes mesenterica, a disease which consists in engorge- 
ment of the mesenteric glands, is likewise a sign of the 
scrofulous constitution, or rather it is scrofula already de- 
veloped in these glands; for the engorgement of the glands 
of the neck, of the arm-pits, of the groin, that of the thyroid 
gland, of the mesentery, the tubereles which constitute 
pulmonary phthisis, are often only varieties of the same 
affection, occupying a different seat; this may also be said 
of the softening and the swelling of the bones, whether 
in infants or in adults. In fact, in the families in which 
these organic predispositions exist, in places where this 
malady is endemic, some are affected with glandular swel- 
lings of the neck or of the groins, others with marasmus, 
pulmonary consumption, rickets, or goitre, or with chronic 
irritations of the eyelids, &c. &c. 

In all these cases it is easy to follow the traces of the 
same morbid character, namely, an abnormal predomi- 
nance of the spongy and lymphatic tissues, together with 
a great tendency of the mucous membranes to contract 
irritation, whence the frequency of ophthalmia, of otor- 



PRACTICE OF MEDICINE. 281 

rhoea, of coryza, of pulmonary catarrhs, of gastroente- 
ritis with the mucous form, in individuals of the scrofulous 
constitution. 

Different names have been given to the scrofulous con- 
stitution, according as it occupies the subcutaneous glands, 
those of the mesentery, the pulmonary tissues, the bones, 
the articulations, &c. 

VARIETIES OF THE SCROFULOUS AFFECTION. 

First variety — Tuberculous Ganglites. — The glands 
of the lateral parts of the neck, from the angle of the 
jaws to the clavicle, those of the arm-pits and of the groins, 
those which occupy the course of the great vessels of the 
limbs, are frequently engorged in scrofulous subjects, and 
give rise to indolent tumours, rounded, soft at first, and 
afterwards renitent. At first isolated, moveable, and of in- 
considerable size, they afterwards develope themselves suc- 
cessively; in a short time they swell, adhere to each other, 
and often form considerable masses, projecting and uneven. 
These engorgements are sometimes observed simultaneous- 
ly in the glands of the neck, of the arm-pits, of the groins, 
and of the mammae, but they may make their appearance 
only on one or more of these points. All the varieties de- 
scribed further on, or some of them, may exist at the same 
time with this form. Scrofulous tumours have a very slow 
progress. They sometimes remain stationary during whole 
months and years; they however gradually enlarge, and 
become painful to the touch; they adhere to the skin, 
which becomes red, of a violet colour, and hot, and grows 
thin on the summit, and at last gives issue to a pus more 
or less serous; but before the disease arrives at this de- 
gree of inflammation, it proceeds more or less slowly, 
becomes stationary, advances, and retrogrades a number 
of times. The tubercles of scrofulous persons take on 



282 THE PHYSIOLOGICAL 

suppuration but partially; hence the ulcers and fistulas 
which permit the escape of portions of softened tuber- 
culous matter. These scrofulous ulcers suppurate during 
a very long time, sometimes during many years, changing 
frequently their forms in depth and in contour, sometimes 
painful but most frequently indolent. New tumours often 
form and suppurate near those which are already in a state 
of suppuration; the cicatrices which are at last formed 
after a period of greater or less duration, are at first red, 
afterwards they become pale, soft, and as it were withered. 

In the greater number of cases, the disease leads to sup- 
puration, but it also sometimes terminates by resolution, 
particularly if it be combated in a suitable manner from 
the commencement. 

We sometimes see tubercles develope themselves on 
many other parts of the body besides those pointed out; 
in some individuals, all the parts furnished with cellular 
tissue are crowded with them. 

The scrofulous tumours which constitute this variety 
are observed at every age, but particularly in infancy. 
This disease ordinarily commences at the period of the 
first or second dentition, or a little before the age of pu- 
berty, rarely at a later period; yet we sometimes see per- 
sons of the age of thirty, forty, or fifty, affected with scro- 
fulous tubercles. When the malady commences in in- 
fancy, and is not complicated with other internal irrita- 
tions, it often terminates happily towards the age of pu- 
berty; this age, on the other hand, is that in which pul- 
monary tubercles most ordinarily form themselves. 

Second variety — Goitre. — The name of goitre is given 
to an abnormal development of the thyroid gland, which 
makes its appearance by a tumour, more or less consider- 
able, before the trachea. 

In certain countries where scrofula is endemic, we ob- 
serve in the inhabitants, sometimes, tuberculous enlarge- 



PRACTICE OP MEDICINE. 2S3 

merits of the glands, at other times, goitres or other forms 
of the disease. All these forms may exist simultaneously 
or separately. Thus, in the vallies of the Alps, we find 
individuals affected with goitre, and without other symp- 
toms of scrofula, while others have tuberculous glandular 
inflammations, ophthalmia, swelled lips, chronic coryza, 
&c. with or without swelling of the thyroid gland. In 
other countries, and under certain influences of climate 
and regimen, scrofula always assumes the same form; for 
example, nothing is more common in Paris than ganglitis, 
rachitis, tubercular phthisis, tabes mesenterica, while we 
rarely meet with a case of goitre. 

Although engorgement of the thyroid gland is most 
frequently one of the forms of the scrofulous affection, it 
may nevertheless supervene accidentally in individuals 
whose constitutions are by no means scrofulous; it is thus, 
without citing other examples, that efforts not unfrequent- 
ly determine it in women in child-bed. 

Third variety — Entero-mesenteric Irritation. — This 
malady, which much more frequently affects infants than 
adults, is recognised by the following signs: after the or- 
dinary symptoms of gastro-enteritis or entero-colitis, the 
belly swells, becomes hard and sensible on being touched; 
in proportion to the progress of the malady, the patient is 
atrophied, we can perceive, through the parieties of the 
abdomen, tumours which are rounded or uneven: these 
are the engorged mesenteric glands; there is excessive 
thirst, anorexia or voracity, obstinate diarrhoea, particu- 
larly towards the termination of the malady, sometimes, 
but rarely, constipation, suppuration of the tuberculous 
glands, hectic fever, marasmus, and death. 

On dissection, we constantly find traces of inflamma- 
tion on the mucous membrane of the intestines, corres- 
ponding with the engorged glands. Tabes mesenterica 
may appear alone, or be acoompanied with one or more 



284 THE PHYSIOLOGICAL 

varieties of scrofula. This disease may also exist acci- 
dentally, and in individuals whose constitutions are not 
scrofulous. 

Fourthvariety — Tuberculous Pulmonary Consump- 
tion. — If individuals of the scrofulous constitution have 
the mucous membrane of the eyes or of the nasal fossae 
very irritable, they will have an ophthalmia or a coryza; 
if irritability predominates in the mucous membrane of 
the intestines, they will be affected with a gastro-mesen- 
teric inflammation; if in the mucous membrane of the bron- 
chia, they will be subject to bronchial catarrhs, then to irrita- 
tions of the pulmonary parenchyma and to tubercles, which 
in these subjects are formed with the greatest facility. 

Although tubercular pulmonary phthisis, caeteris pari- 
bus, makes its appearance more readily in individuals 
predisposed, it nevertheless very often supervenes with- 
out this predisposition, and under the influence of all the 
causes that irritate the organs of respiration. As it has 
been treated of in the chapter on pulmonary phthisis, we 
shall not return to the consideration of it. (See Chronic 
Pneumonia and Pulmonary Phthisis.) 

Fifth variety — Rachitis. — We should refer to this va- 
riety various alterations of the osseous tissue, such as the 
softening of the bones and the deformities which are the 
consequence of it in infants, many white tumours of the 
articulations, and often spontaneous caries of the bones at 
all periods of life. Rachitis ordinarily manifests itself in 
children between the ages of six and seven, by some of 
the following signs, or by the simultaneous existence of 
them all: the muscles are flaccid, the visage pale, the head 
becomes large, the articular extremities swell, the bones 
of the legs become crooked, the vertebral column under- 
goes various deviations, the ribs are depressed, and the 
sternum rises to a point, dentition is slow and the teeth 
are shed very early, the abdomen is tense, a circumstance 



PRACTICE OP MEDICINE. 285 

which ordinarily depends upon a concomitance of an en- 
gorgement of the mesenteric glands, and there is then di- 
arrhoea. If the vertebrae are tumefied, they affect the ac- 
tion of the spinal marrow, and the child cannot sustain it- 
self on its lower extremities, or can do it only with diffi- 
culty; sometimes the affected bones become carious. 

Ossification always proceeds slowly in scrofulous sub- 
jects, and the articular extremities in particular remain a 
much longer time bathed in liquids, soft and cartilaginous, 
than in other individuals. This constitution of the bones 
disposes them to become readily irritated, and to swell and 
undergo various kinds of alterations, as is proved by an 
observation of facts. 

Sixth variety — Ophthalmia, Coryza, Otorrhcea of 
Infants. — The irritations of the mucous membranes of 
the eyes, of the nose, and of the ears, have been described 
in another place. Taken by themselves, they are not 
symptoms of the scrofulous affection, for we remark them 
frequently in children of all constitutions, but when to 
these signs is superadded the scrofulous habit, which a 
practised eye easily recognises, and which we have de- 
scribed above, when in infants the borders of the eyelids 
are habitually swelled, and obstructed with rheum, when 
the mucous membrane of the nose is covered with scabs, 
which fall off, and reappear frequently, we may regard 
these irritations as scrofulous. Ophthalmia depending 
upon this cause, as well as inflammation of the mucous 
membrane of the nose, is observed most frequently in in- 
fancy, but adult age is not exempt from it. 

These irritations often exist simultaneously with other 
varieties of scrofula. 

The scrofulous affection is endemic in most of the hu- 
mid ;md low countries, in gloomy vallies, and in marshy 
places. In the large towns we observe it principally in 
individuals who belong to the more indigent classes of so- 
37 



286 THE PHYSIOLOGICAL 

ciety, and who are obliged to live in confined and dark 
quarters, where they respire a vitiated air. The absence 
of the light of the sun appears to have upon man an in- 
fluence analogous to that which it is observed to have in 
plants which grow in the shade or in caves; these plants 
are watery, without colour, etiolated; now the scrofulous 
constitution is a species of etiolation, and assimilation pro- 
ceeds badly; nutrition is as it were arrested. In the etiology 
of this malady we must also take into account its heredi- 
tary character; this does not consist, we are well aware, 
in the transmission, from parents to their children, of the 
germ of scrofula, but in the transmission of an organic 
disposition analogous to their own; that is, a predominance 
of the cellular tissue and the lymphatic system, associated 
with a remarkable irritation of the mucous membranes, 
which disposition existing, the occasional causes more 
readily develope the disease than when the predisposition 
does not exist: such is the true theory of all the maladies 
called hereditary. 

In the greater number of cases, scrofula occurs in indi- 
viduals whose constitution is disposed to this disease, but 
it may manifest itself in other individuals, who are ex- 
posed to humidity or cold, and who live in dark places; 
thus, we observe it in subjects of good constitutions, who 
are confined during a long time in obscure and damp dun- 
geons, in those who inhabit mines, &c. To these causes 
may be added want of exercise, bad nourishment, want of 
cleanliness. It is observed, that the scrofulous constitu- 
tion is readily contracted by those who leave a warm cli- 
mate to inhabit a colder one, and also that it is often dis- 
sipated by opposite means. The appearance of the disease 
under one form rather than another, is accounted for by 
the action of the causes upon certain parts rather than 
others, or by the fact, that some parts are more irritable 
than others; thus, ganglites develope themselves prompt- 



PRACTICE OF MEDICINE. 287 

ly in the individual, who, being predisposed to the dis- 
ease, exposes himself suddenly to cold or humidity; in an- 
other, the glands of the mesentery suffer engorgement; in 
a third, the osseous extremities swell, and are affected 
with caries, under the influence of an external cause often 
unperceived; a fourth is affected with an ophthalmia, a 
coryza, a chronic bronchitis, a tubercular phthisis; some 
patients experience all these disorders simultaneously, or 
at different times. 

There exist, besides, other forms of the scrofulous af- 
fection, such as certain indurations of the skin, ulcerations 
upon different parts of the body, particularly upon the 
legs, tuberculous sarcocele, &c. 

The scrofulous affection is by no means contagious. 

Prognosis. 
Tuberculous ganglites most frequently terminate by 
cure towards the adult age, when there is no internal 
complication; tabes mesenterica and tuberculous phthisis 
almost always terminate fatally; rachitis, if there be too 
active a complication of the spinal marrow, or caries of the 
vertebrae, is almost always fatal. If it is accompanied 
with tumefaction of the abdomen, this complication of 
entero-mesenteritis offers but few chances of cure. If 
there be only a development, somewhat greater than na- 
tural, of the articulations of the feet, of the knees, of the 
wrists, without other complication, the process of ossifi- 
cation may re-establish itself and the infant enjoy good 
health. The danger which results from caries, from ar- 
ticular tumours, is determined by their extent, and their 
seat, permitting or not the practice on these parts of ap- 
propriate operations and entrenchments. In all these 
cases we must take into consideration the internal organs 
which may be affected. 



288 THE PHYSIOLOGICAL 

Treatment. 

Prophylactic. — We may to a certain degree prevent 
the development of scrofula in individuals predisposed or 
born of scrofulous parents, by withdrawing them at an 
early period, from the influence of the causes which may 
occasion it. The most appropriate means are those which 
have a tendency to bestow upon the muscular, nervous, 
and sanguineous systems, the energy and activity in 
which they are deficient, and to destroy the predominance 
of the cellular and lymphatic systems. 

Residence in the country in a pure and dry atmosphere, 
under the influence of the solar light, and manual exercises 
in the open air, hold the first rank among the curative 
means, and all means may be considered insufficient as 
long as the children who are predisposed are permitted to 
live in narrow, damp, dark streets, or crowded together 
in manufactories, hospitals, &c; the same may be re- 
marked of the inhabitants of vallies in which the scrofu- 
lous constitution is endemic. It would be desirable for 
these individuals to live, at least for some years, under a 
more healthful sky. A native of a warm country, if he 
has a scrofulous constitution, should not take up his resi- 
dence in a colder climate, and even when there is no pre- 
disposition, it is not uncommon to see individuals of 
southern countries contract the scrofulous afiection and 
pulmonary consumption, on removing to more northern 
latitudes; for the opposite reason it is very advantageous 
to leave a cold and humid country to reside in a warmer 
and drier one. 

It is of advantage that the mattresses upon which the 
children lie contain some aromatic substances, such as 
fern, lavender, sage, &c. If the spine begins to be curv- 
ed, we make the child lie exactly upon the point which 
becomes prominent. If the child who has the predisposi- 



PRACTICE OF MEDICINE 289 

tion has already began to apply himself to study, it should 
be entirely suspended, to enable him to engage with full 
liberty in muscular exercises. 

The food should be substantial and strengthening, and 
should principally consist in boiled or roasted meats, eggs; 
fresh vegetables, and fruits perfectly ripe, are to be asso- 
ciated in proper proportions with the animal food. For 
drink, wine or strong beer is to be used. In employing 
this regimen, we must watch the state of the digestive or- 
gans, for we know that the mucous membranes have a 
great tendency to contract irritation in scrofulous consti- 
tutions, but by giving activity to the skin, to the muscles, 
and to the circulatory system, by means of exercise, we 
diminish at the same time this irritability of the mucous 
membranes, and if in large towns the tonic regimen has 
so little success, it is because the vital activity not being 
distributed over the muscles and skin, the mucous mem- 
branes possess it in excess, and become inflamed with the 
greatest facility. Certain tonics are likewise prescribed, 
such as the ferruginous preparations, those of quinine, de- 
coctions of gentian, of the hop, the wine of wormwood, 
&c; but these articles must not be employed except with 
moderation, and in cases in which the digestive organs 
are in a state of perfect soundness. Might we not employ 
iodine internally, and at distant intervals, as a means pro- 
per to prevent the formation of tubercles? 

Stimulating, salt, or sulphurous baths, and dry friction, 
are, next to the influence of dry air, exercise, and 
food, one of the most, advantageous means of cure, on ac- 
count of their keeping up Die action of the skin. For the 
same reason we should be careful to protect itagainst cold 
and dampness. 

If local irritations, particularly of an internal kind, su- 
pervene, the tonic regimen must be suspended and replac- 
ed by emollients and a suitable regimen. 



290 THE PHYSIOLOGICAL 

Curative Treatment. — Scrofulous tumours should be 
attacked at their commencement by small topical bleed- 
ings often repeated; they act then as an antiphlogistic and 
revulsive means, and if the external irritation is not com- 
plicated with inflammation, we may administer the tonics 
mentioned above, and associate this treatment with the en- 
joyment of free air and the other means of hygeia. But 
when the tumours are old, it-is not possible to obtain their 
resolution by means of leeches ; their employment would 
even be dangerous by augmenting the local and general 
weakness. We apply then to the tumours stimulants of 
various kinds, to induce suppuration in them; of this kind 
are the plasters of soap, ammoniacal liniments, the oint- 
ment of styrax, the ointments of iodine, &c. If the tu- 
mours are not yet tubercular, it sometimes happens that 
these applications, and particularly those of the hydriodate 
of potash, produce their resolution. 

Scrofulous ulcers should be dressed with lint spread 
with cerate; if the flesh is pale, we excite it gently with 
cream of tartar in powder, or a brisk digestive. If they be- 
come sanious or gangrenous, we have recourse to slices 
of lemon deprived of their rind, to lotions of the chloride 
of soda, and if the ulcers are painful, we employ the opi- 
ate cerate and emollient cataplasms. When the ulcers tend 
to cicatrization, we must endeavour to prevent the defor- 
mities which the cicatrices leave after them, by often re- 
pressing the flesh with nitrate of silver, by cauterizing the 
elevations formed by the skin, and the vegetations which 
spring up. Tabes mesenterica, or entero-mesenteric irrita- 
tion should be treated as chronic gastritis and gastroen- 
teritis; this variety, as well as tubercular phthisis, requires 
the internal employment of emollients. (See Gastritis and 
Pulmonary Phthisis.) 

Rickets should be treated by the means of hygeia in- 
dicated above, as preventives of scrofula, but we suspend 



PRACTICE OP MEDICINE. 291 

the employment of internal stimulants, if irritation arises. 
Furthermore, we should in all cases watch the state of the 
digestive organs, and be determined by it in permitting, 
diminishing, augmenting, or retrenching the strengthening 
alimentation. We correct the deviations which the bones 
may have undergone by the employment of various or- 
thopedic means, the consideration of which cannot find a 
place in this work. 

The tumours of the articulations, called white tumours, 
should be attacked in the commencement by leeches ap- 
plied to the parts, afterwards by revulsives, blisters, moxa. 
Absolute rest. The internal treatment should be tonic, 
unless contra-indicated by complications. 

Scrofulous ophthalmia and coryza do not demand any 
specific local treatment; we pursue the same course as in 
the cases in which the irritations depend upon any other 
cause. If they are acute, local bleedings and emollients; 
if chronic, revulsives. The internal treatment is the 
same as that of other varieties of scrofula, that is, exciting 
or emollient, according to the state of the digestive and 
respiratory organs. 

To sum up the treatment: free air, exercise, the light 
of the sun, the excitation of the skin by baths, friction, 
and woollen clothing, a tonic and stimulating alimentation, 
unless contra-indicated, form the basis of the means pro- 
per to remove the scrofulous constitution; the local in- 
flammations, acute or chronic, internal or external, which 
supervene, should be treated as inflammations produced 
under the influence of any other cause. 

PERIODICAL IRRITATIONS. 

B M I TTI.V ! I l.\ KHS.) 

Most of the affections which have been treated of may 
assume the intermittent form, but the intermittent charac- 



292 THE PHYSIOLOGICAL 

ter is more frequent, when the irritation has its seat in 
certain tissues than in others. Thus the irritations of the 
sanguineous system which are called inflammatory, are 
those with which we most frequently meet under this 
form. 

Nervous irritations likewise affect very often the peri- 
odical form. 

The white or lymphatic tissues are much more rarely 
the seats of periodical irritation, because, the irritation 
once fixed in these tissues, is with difficulty displaced. 

These irritations may, like the continued, be seated in 
all the organs; thus we see intermittent ophthalmia and 
erysipelas. But the most common seats of these affections 
are in the alimentary canal, and as in this case the seat of 
the disease is not so manifest as in the others, authors 
have made of it an essential or legitimate intermittent fe- 
ver, as they also call those maladies by the name of es- 
sential continued fevers, which at the present day are re- 
cognised as being gastro-enterites. 

Legitimate intermittent fever is demonstrated to be but 
a gastro-intestinal irritation, by the following proofs; first, 
there is, as in continued fevers, redness of the tongue, 
ardent thirst, lassitude of the limbs, augmentation of fever 
by the ingesta of stimulants during the access; secondly, 
the intermittent fever often changes into the continued, 
or it may be made to undergo this transformation by an 
ill-timed stimulating medication; and dissection then re- 
veals the same alterations as after other chronic or acute 
continued gastro-enterites. 

Intermittent fevers may be accompanied with diverse 
phenomena: thus we sometimes observe during the attack, 
pneumonia, violent cephalalgia, coma, delirium, convul- 
sions, syncope, icterus, aphonia, adynamy, ataxy, vomit- 
ing, and various other alarming symptoms, which have 
occasioned the name of pernicious to be given to these 



PRACTICE OF MEDICINE. 293 

fevers. But every intermittent fever at a very high degree 
may become pernicious, as every violent continued fever 
may promptly assume the adynamic, ataxic, putrid, or 
typhoid form. 

Authors give the name of masked fevers to external 
intermittent irritations, such are a nasal haemorrhage, a 
haemoptysis, an erysipelas, a cutaneous eruption, a rheu- 
matism, &c. with a periodical form. But these irritations 
are the least masked of all; they are only external local 
irritations, which are intermittent instead of continued. 
They are often complicated with internal, and particularly 
gastro-intestinal irritation, or they are an effect of it; this 
is a circumstance likewise which we often observe in con- 
tinued irritations. When the external intermittent irri- 
tation exists without internal complication, the phenome- 
na are confined to local inflammation, provided it be not 
very violent; but if there is at the same time intestinal 
irritation, we have all the ordinary symptoms of the legi- 
timate intermittent fever of authors, with the external 
local affection superadded. In one word, intermittent 
irritations sometimes develope febrile phenomena, and 
this most frequently happens; at other times they do not 
develope them: this is also the case with continued phleg- 
masiae. 

According to this theory, the proofs of which the limits 
of this work will not permit us to detail, we may establish 
the following propositions: — 

1st. The intermittent fevers ealled legitimate, are pe- 
riodical gastro-enterites. 

2d. Pernicious fevers are irritations of the same na- 
ture at a very high degree, or at the same degree, but in 
a very irritable subject, or finally with complication of 
irritation in important organs. 

3d. Masked fevers arc nothing but external intcrmit- 
38 



294 THE PHYSIOLOGICAL 

tent irritations, sometimes without and sometimes with 
fever; in the latter there is more frequently intermittent 
gastro-enteritis, which again may be legitimate or per- 
nicious. 

Periodicity does not exclude the idea of irritation, as 
some authors pretend to assert; we see, on the contrary, 
that in the physiological order, most of our functions are 
performed with a certain periodicity, the result of a sur- 
excitation of the organs which execute them, such are 
hunger, the alvine evacuations, sleep, the menstrual dis- 
charge, &c. 

Periodical, like continued irritation, is composed of a 
fluxionary movement towards the irritated organ, but in 
continued irritation the congestion is permanent; in place 
of which, in the intermittent, a reaction is established to- 
wards the periphery of the body, and the equilibrium is 
re-established. If the congestion is very violent, and par- 
ticularly if it occurs in very important organs, death may 
supervene very promptty. These are the cases of perni- 
cious fever. If the congestion is often repeated, the or- 
gans at last retain the irritation, and we have continued 
fever, or they undergo remarkable alterations of structure, 
and principally congestions, as we observe in the spleen 
and the liver, in the sequel of intermittent fevers of long 
duration. 

This theory of intermittent fevers is far from being ad- 
mitted by all physicians; many have no theory upon the 
subject. Some, a priori, make them depend upon a mo- 
dification of innervation produced by deleterious causes, 
and principally by paludal emanations acting upon the 
nervous centres, and especially upon the spinal marrow, 
after the manner of certain poisons. Admitting, with 
these authors, the influence of marshes as the occasional 
cause, which is incontestible, we believe their opinion 
upon the nature of the fever to be a pure hypothesis, con- 



PRACTICE OP MEDICINE. 295 

firmed neither by an observation of phenomena, nor by- 
dissections. 

Every periodical febrile irritation embraces two prin- 
cipal periods — that of the access, and that of the apyrexia, 
or the interval without fever, which exists between each 
two successive accesses. 

The access is composed of three principal phenomena, 
which are named stages — the cold, the hot, and the sweat- 
ing stages. The cold stage results from the rapid afflux 
of blood towards the irritated organ; the hot and the 
sweating stages are the effect of a reaction of this organ, 
which throws back the blood on the periphery of the 
body which it had abandoned. 

We give the name of type to the order which the at- 
tacks observe in their return — if the attack returns every 
day, it is the quotidian fever; if every other day, it is the 
tertian fever; if every sixty-two hours, it is the quartan 
fever, and so forth ; these three types are the most com- 
mon, and we rarely meet with the quintan fever, the sex- 
tan fever, &c. 

The fever is called intermittent when the apyrexia is 
complete; remittent, when it is incomplete; that is, when 
the morbid phenomena do not completely cease, but only 
abate in intensity between the attacks; subintrant, when 
the attacks encroach upon each other; in this case, the 
cold stage recommences before the sweating stage has ter- 
minated. 

Fevers arc called atypic or erratic, when the return 
of the attack is irregular; abnormal, when the attack is 
not composed of all the stages, but either the cold, the 
hot, or sweating stage is wanting. 

Every legitimate periodical irritation, if it is exas- 
perated by the treatment, or by the influence of causes 
continually acting, may be changed into the remittent or 
subintrant, and this aeain into the continued form; in the 



296 THE PHYSIOLOGICAL 

same manner may an appropriate treatment cause the re- 
mittent form to assume the intermittent, which is always 
an amelioration. 

The most common causes of intermittent fevers are, be- 
yond a doubt, the influence exercised upon the economy 
by marshes, by the vicinity of ponds, lakes, rivers and ca- 
nals, whose borders remain always dry, stagnant pools, 
forests, common sewers, ports of the sea badly cleaned, 
by hot and rainy seasons, &c. &c. These causes exercise 
their influence so much the more readily, as individuals 
are badly nourished, are fatigued, or are affected with a 
chronic malady. The presence of foreign bodies in the 
economy, such as worms, calculi, and the moral affec- 
tions, have also been placed among the number of causes 
determining this disease, but these causes are extremely 
rare, compared with the influence of marshes. 

Symptoms of the Intermittent Fever called Legiti- 
mate — Coldstage. — Pandiculation, lassitude of the limbs, 
sense of pain and malaise in the arms, and sometimes in 
the extremities of the fingers; this is succeeded by shi- 
vering and chattering of the teeth, produced by a sensa- 
tion of cold, in the lumbar region at first, but afterwards 
pervading- the whole body, nausea or vomiting, embar- 
rassed respiration, pulse small and accelerated, redness of 
the tongue, dryness of the mouth, thirst, limpid urine. — 
Hot stage. After the lapse of a period varying in 
duration, the sense of cold is dissipated by degrees, and 
is replaced by heat of a dry, pungent kind, more or less 
intense; the skin is burning, and the urine high-coloured; 
the pulse full, strong, and hard; the mouth is dry and the 
thirst extreme; there is violent cephalalgy, sometimes ac- 
companied with wandering of the mind. — Sweating 
stage. When the heat has arrived at a degree which is 
sometimes excessive, it is at last replaced by abundant 
sweats, and by a gradual diminution of all the symptoms; 



PRACTICE OF MEDICINE. 297 

the sweating stage having terminated, the patient finds 
himself in his natural state, with the exception of a sense 
of lassitude, which disappears more or less completely 
during the apyrexia. The duration of a complete access 
varies from six to twelve hours. 

Symptoms of the Intermittent Fever called Perni- 
cious. — To the preceding symptoms are added sudden 
prostration of strength, as in adynamic and ataxic fevers; 
or there supervene some other violent and dangerous 
symptoms, of which we have spoken above. According 
to the predominance of some particular symptom, authors 
give these fevers a particular name; thus they have per- 
nicious fevers, which they call pneumonic, pleuritic, car- 
dialgic, syncopal, exanthematous, comatose, convulsive, 
epileptic, &c. &c. 

The symptoms of masked fevers vary according to the 
seat of irritation; thus we have ophthalmia, nasal haemor- 
rhage, haemoptysis, erysipelas, periodic neuralgia, &c. 
During the access, every thing resembles the continued 
irritations. These irritations exist with or without fever, 
according as there is or is not gastro-intestinal irritation, 
either primitive or consecutive. 

The symptoms of remittent fevers are the same during 
the attack as those of intermittent fevers; the difference is 
that the apyrexia is not complete in the former; this has 
given occasion to certain authors to assert that these were 
cases of continued fever with the addition of intermittent 
fever; this opinion is absurd. There is remission and not 
complete intermission, because there exists permanently a 
point of inflammation. 

Prognosis. 
The intermittent fevers called legitimate, are removed 
with considerable facility, if they are recent, and have 
not yet produced organic disorders of an important cha- 



298 THE PHYSIOLOGICAL 

racter, &c. The quotidian and tertian fevers are in gene- 
ral more easily cured than the quartan. The intermittent 
fever with a pernicious form, proceeds rapidly to the 
fatal termination, the danger increases at every access, 
and it often terminates in death during the third, fourth, 
or fifth attack. The fevers called masked, are attended 
with but little danger, when the external irritation exists 
without internal complication; when this complication ex- 
ists, the prognosis is based upon it, and is consequently 
that of legitimate and pernicious fevers. 

Intermittent fevers often transform themselves into re- 
mittent, and then into continued fever; they may deter- 
mine different organic alterations, sanguineous conges- 
tions, engorgements of the liver, of the spleen, &c. drop- 
sies, aneurism. 

Treatment. 

In the fevers called legitimate, we commence by calm- 
ing the irritation by means of topical bleeding and emol- 
lient drinks, especially when the subject is strong and 
plethoric; when the irritation has diminished, we adminis- 
ter bark, and principally the sulphate of quinine, during 
the apyrexia, and never during the attack. The quantity 
of the sulphate is from six to twelve grains, divided into 
doses of two or three grains, and taken during each 
apyrexia. 

We should also continue its employment during some 
time after the attacks have ceased, and diminish the doses 
by degrees. In want of the sulphate of quinine, we give 
the bark in decoction rather than in powder. 

The most proper time for the administration of the fe- 
brifuge remedies, is three or four hours after the attack has 
entirely terminated, but we must not forget that the apy- 
rexia must be complete to allow the employment of this 
medicine. 



PRACTICE OF MEDICINE. 299 

Many stimulating and tonic substances have in their 
turn been proposed as succedaneous to quinine and its 
numerous preparations, but the quinine merits hitherto 
the preference, because it produces, with more certainty 
than any other medicine, upon the intestinal canal, the 
modification, the stimulation, or perhaps the counter-irri- 
tation proper to break up the periodicity, and prevent the 
return of the attack. These substances are almost all the 
bitters, as the wormwood, the willow, the oak, the drupe 
of the walnut, &c; arsenic has also been employed, as 
well as opium, musk, camphor, white wine, gunpowder. 
The attacks have sometimes been prevented by means of 
ligatures applied upon the limbs, to intercept the venous 
circulation, and prevent the afflux of blood towards the 
viscera. 

Moral impressions have sometimes produced a cure 
when all other means have failed; it is to these impres- 
sions that the effect of amulets and of disgusting substan- 
ces, such as spider's web, urine, faeces, the wood-louse, 
&c. must be attributed. An instance is quoted of a young 
man who was cured, after all other means had been ex- 
hausted, by a fit of anger which had been designedly 
provoked. 

The treatment of pernicious fevers does not differ from 
the preceding, except that it ought to be much more 
active, on account of the danger attending a return of the 
attack. If there is violent congestion of the lungs, of the 
brain, of the liver, or inflammation of the organs of diges- 
tion, we must have recourse to a copious abstraction of 
blood during the attack, and prevent its return by the ad- 
ministration of the preparations of bark in high doses. 

Remittent fevers should be brought to the intermittent 
state. We obtain this object by the antiphlogistic treat- 
ment, blood-letting, rest, and diet; these means always 
diminish the remittent character, and bring back the fever 



300 THE PHYSIOLOGICAL 

to the legitimate intermittent character. This having been 
accomplished, we give febrifuges during the apyrexia, as 
in the preceding cases. If the fever becomes continued, 
the treatment is the same as that of common continued 
fever, that is to say, it is antiphlogistic. (See Gastro- 
enteritis. ) 

In the fevers called masked, whenever the intermittent 
irritation is without fever, we may administer bark inter- 
nally without hesitation, and at all periods, because there 
exists no gastric irritation j but if there is fever we pur- 
sue the same course as in legitimate intermittent fever. 

General Rule. — To obtain a solid cure of intermittent 
fever, we must combat the two elements that compose it, 
the sanguineous congestion and the periodical movement 
which produces it. For this purpose we exert ourselves 
first to procure the cessation of the sanguineous tumes- 
cence, and the accidental complications: we obtain this 
end by local or general bleedings, more or less abundant, 
according to the case, but we dispense with the abstraction 
of blood if the congestion is moderate: this object being 
attained, we can conquer the periodicity by means of 
quinine. 

dropsies. 

Dropsy, which is more frequently a secondary affection, 
is characterized by the presence of a serosity, which is 
exhaled and afterwards absorbed in the normal state, but 
which in the morbid state remains, and accumulates in the 
diverse cavities lined by the serous membranes, or in the 
synovial membranes or the cellular tissue. This accumu- 
lation presupposes either an absorption very much dimi- 
nished, or a secretion very abundant. The secretion of 
serosity is augmented in certain irritations, which group 
themselves below the phlegmasia; absorption is diminish- 



PRACTICE OF MEDICINE. 301 

ed in certain cases of debility, and by the existence of 
certain obstacles to the circulation of the blood and other 
fluids. 

Symptoms. 

Dropsy is general or local. It is so easily recognised 
that it is useless to enter into a detail of all the signs that 
characterize its existence. General dropsy is called ana- 
sarca, local dropsy receives different names according to 
the seat which it occupies. That of the brain is called 
hydrocephalus, that of the thoracic cavities, hydrothorax, 
and hydropericardium; that of the cavity of the abdomen, 
ascites; that of the spinal canal, hydrorachis; when the 
serosity is accumulated in a cyst developed by a morbid 
process, it is called encysted dropsy, &c. 

When dropsy takes place rapidly, the skin is not ordi- 
narily doughy, nor does it retain the impression of the 
fingers; the contrary is the case when it is developed 
slowly, which usually happens. 

General dropsy usually commences in the inferior ex- 
tremities. Partial dropsy, on the contrary, commences in 
or near the particular place in which the cause exists; but 
in some cases we do not suspect it until warned of its ex- 
istence by oedema of the feet and eyelids. Partial dropsy 
is often complicated with anasarca, particularly at an ad- 
vanced period. 

Dropsy of the brain is not primitive or essential; it is 
always the result of an irritation of the serous membranes 
which invest it. The symptoms are those described in 
the articles on cerebral irritations and arachnitis of in- 
fants. 

These remarks arc applicable likewise to dropsy of the 

cavities of the chest; there is not perhaps a well attested 

example of primitive hydrothorax: the disease depends 

upon an inflammation of flu- pleurae, or upon the existence 

39 



.102 THE PHYSIOLOGICAL 

of an obstacle to the circulation, having its seat in the 
heart or the lungs. If an exhalation of serosity should 
occur as a consequence of arrested transpiration, or of cold 
drinks taken in large quantities, without any diseased 
complication, the effusion would soon be absorbed. 

The peritoneal is, of all the cavities, the one which is 
most frequently the seat of dropsy. The swelling of the 
abdomen, and the movement of fluctuation which percus- 
sion occasions, leave no doubt as to the diagnosis; in ad- 
dition to this, it is not long before oedema of the inferior 
extremities and anasarca supervene. Ascites is distin- 
guished from tympanitis by the tumefaction not being 
elastic and sonorous in the former as it is in the latter. 

This dropsy is but seldom primitive; it is more fre- 
quently occasioned by a peritonitis, or by an obstacle to 
the circulation, produced by an engorgement of the liver, 
of the spleen, of the ovaria, or of the mesenteric glands. 

The encysted dropsy, which developes itself between 
the abdominal muscles and the peritoneum, is distinguish- 
ed from peritoneal ascites by the fact, that the swelling, 
at first partial and gradual, occurs in one of the sides of 
the abdomen, and increases in an unequal and irregular 
manner; the functions are but little, or not at all altered, 
and the face is neither pale nor bloated, except in the last 
stage of the disease. Dropsy of the ovarium is not always 
easily recognised; we find a tumour more or less consi- 
derable in size in one or both sides of the hypogastric region, 
attended with little pain, developing itself slowly, present- 
ing sometimes fluctuation, a slight oedema of the inferior 
extremities, sometimes oppression; menstruation is irre- 
gular, the general functions are not troubled, except to- 
wards the latter stages of the malady. 

Dropsy of the cavity of the uterus has often been con- 
founded with pregnancy, or with engorgement of this vis- 
cus; yet there is perceived through the parietes of the ab- 



PRACTICE OF MEDICINE. 303 

domen, if an attentive examination be made, an obscure 
fluctuation, which however is sufficiently manifest to the 
touch; in practicing the "ballottement," the finger, placed 
upon the neck of the uterus, is not struck by any solid 
body; after the lapse of some months, the absence of the 
movements of the infant remove all idea of the existence 
of pregnancy. In certain cases we find hydatids in the 
uterus, or we find one or more cysts filled with a purulent 
serosity, which is extremely fetid. This dropsy is always 
an effect of a chronic inflammation, or of an organic affec- 
tion of the uterus. 

The same is the case with regard to encysted dropsy of 
the liver, the diagnosis of which is very difficult, as the 
fluctuation is very obscure, and the pale complexion, the 
oppression, the dull pain, and the elevation of the right 
hypochondrium, may be equally produced by engorge- 
ment of the liver, without any accumulation of fluids. 

Encysted dropsies may also occur in various other parts 
of the body, as in the epiploon, the mesentery, the 
spleen, &c. 

Causes. 
The predisposition to dropsy consists in a considerable 
development of the lymphatic system, with a deficiency 
of activity in the sanguineous system ; weak and exsan- 
guious constitutions are most exposed to it. Although of 
more frequent occurrence in infancy and old age, yet all 
periods of life, as well as all temperaments, are liable to 
the disease. Its occasional cause is sudden suppression of 
the cutaneous transpiration; it then becomes necessary to 
the maintenance of the equilibrium, that the kidneys and 
lungs discharge what the skin ceases to evacuate; but 
it sometimes happens that the action of exhalation is 
transferred to the serous membranes or the cellular tissue, 
instead of these viscera, and the sudden supervention oi 



304 THE PHYSIOLOGICAL 

dropsy from the impression of cold is then the result. It 
is also by diminishing cutaneous action, that a humid at- 
mosphere concurs in the production of this disease. Irri- 
tation of the viscera may occasion a rigor, which produces 
dropsy in the same manner, by the afflux of serosity which 
takes place from the surface to the interior. Similar ef- 
fects are produced by the attacks of intermittents. Terror 
or horror may act in the same manner. The ingestion of 
a great quantity of fluids often determines dropsy, parti- 
cularly if they are taken cold while the body is heated. 

Sanguineous pfethora, as the experiments of Majendie 
show, sometimes produces such embarrassment in the eco- 
nomy, as to prevent the process of absorption, and thus 
may give rise to dropsy. 

Inflammation of the serous membranes that line the dif- 
ferent cavities of the body, as the membranes of the brain 
and spinal marrow, the pleurae, the peritonaeum, the peri- 
cardium, are very common causes of dropsy. 

It may likewise be produced by the inflammation of the 
viscera contained in these envelopes, as this inflammation 
may extend to the serous membranes and produce derange- 
ment of their functions. 

The most common causes are obstacles to the circula- 
tion, situated most frequently in the heart and in the great 
arterial trunks. Dropsy from this cause does not arise from 
superabundant exhalation, but from a real difficulty of ab- 
sorption. We should partly refer to this cause dropsies 
which are co-existent with inflammatory or sub-inflamma- 
tory tumours of the liver, of the spleen, of the womb, and 
of the ovaria. 

Dropsy is sometimes produced by the too copious ab- 
straction of blood; the tissues from this cause become re- 
laxed, the blood less rich in fibrin, and effusion conse- 
quently more easily occurs. This is not, however, so fre- 
quently a cause as is usually said; on the contrary, blood- 



PRACTICE OF MEDICINE. 305 

letting usually diminishes plethora, whether general or 
local, and thus facilitates absorption; on this account, 
blood-letting is, in a very great number of cases, the best 
remedy of dropsy. 

Food of a bad quality, or deficient in quantit}', may be 
the cause of this disease, as has been observed in years of 
great scarcity. 

It may be occasioned by the abuse of purgatives, and 
of alcoholic drinks, which produce irritation of the ali- 
mentary canal. 

Dropsy has been divided into active and passive. To 
speak with rigorous accuracy, there are no passive drop- 
sies, except those which depend upon excessive loss of 
blood, on bad nourishment, and on the existence of obsta- 
cles to the circulation; which obstacles, as they are really 
the result of chronic inflammations, are more deserving of 
the attention of the physician than the dropsy itself. 

Prognosis. 

Dropsy, if a primitive affection, sometimes disappears 
spontaneously by a copious evacuation of urine, an abun- 
dant perspiration, or a diarrhoea. This has brought into 
vogue so many articles of the materia medica in this dis- 
ease, such as diuretics, sudorifics, and purgatives. Cures 
have sometimes been obtained by the employment of these 
stimulants, even when dropsy has depended upon an in- 
flammation; absorption occurs, but it is sometimes at the 
expense of a violent inflammation, which carries off the 
patient. 

When there is profound organic derangement of the 
viscera, much reliance is not to be placed on remedies, no 
matter of what kind they may be. If the skin is doughy, 
and retains for a long time the impression of the fingers, 
the case is serious. The ocdematous tissues sometime? 
take on inflammation and become gangrenous. 



306 THE PHYSIOLOGICAL 

Treatment. 

Variable, according to the cause, the degree, the dura- 
tion, and the complications of the disease. It may be es- 
tablished as a general rule, that if the effusion is the effect 
of acute, or which is more frequently the case, of chronic 
inflammation of the viscera, the treatment should be that 
of these affections. Thus, if there is gastro-enteritis, he- 
patitis, peritonitis, pleurisy, pericarditis, arachnitis, tu- 
mours of the liver, of the ovaria, or of the womb, these 
different affections must be combated by appropriate mea- 
sures, generally by the antiphlogistic treatment. 

In a robust and plethoric subject, in whom dropsy is 
dependent upon too copious an exhalation of fluids, unac- 
companied with lesion of structure, we employ venesec- 
tion to promote activity of absorption ; we then administer 
diuretics, commencing with the mildest. In all cases in 
which the effusion is sufficiently abundant to admit of pa- 
racentesis, without danger of wounding the intestines, we 
must resort to this operation early, as by this means diu- 
retics are enabled to act more favourably, and as the dif- 
ficulty attending absorption is greater in proportion to the 
quantity of serosity that has been effused. We evacuate 
likewise the water contained in the cavity of the pleura, 
and in the other cavities which allow of the operation. 
The action of the skin is to be excited by dry vapours, by 
the vapour of aromatic and alcoholic articles, by dry fric- 
tion, by the patient exposing himself to the influence of 
the sun, and by his avoidance of cold and dampness. 

When dropsy depends upon loss of blood, or an exsan- 
guious condition of the patient, or is produced by priva- 
tions and defective nourishment, we not only use diure- 
tics, but also tonics, such as iron, chalybeate wine, prepa- 
rations of cinchona, and particularly food of a good quali- 
ty, at the same time that we carefully watch the alimen- 



PRACTICE OP MEDICINE. 307 

tary canal. If the patient had been for a long time upon 
a poor diet, we should not be in haste to exchange it for 
a very substantial mode of living; but commence by giv- 
ing him milk, the juice of fresh vegetables, cooked fruits, 
and gradually put him upon the use of more nourishing 
articles. 

Drastic purgatives either cut short the disease, or give 
it redoubled intensity. Purgatives of all kinds should be 
proscribed, wherever there exists irritation of the primse. 
viae. 

Among the diuretics, the juniper-berry, the strawberry, 
the dog-grass, the bugloss, and the elder-bark, are parti- 
cularly recommended; the decoctions of these substances 
may be rendered more active by the addition of three or 
four drops of the tincture of cantharides, or fifteen, twenty, 
or thirty grains of the nitrate of potash to the pint. We 
likewise employ squills, the wine of squills, muriatic or 
citric ether, mixed with water, Seltzer water, iodine in 
friction, or internally. Digitalis does not possess a diu- 
retic property in so high a degree as is generally suppos- 
ed, but it is of great utility when dropsy depends upon a 
disease of the heart. 

White wine acidulated, and alcohol diluted with water, 
punch, &c. arc sometimes administered. But all these re- 
medies being more or less stimulating, more or less irri- 
tating, require during their employment attention to the 
state of the intestinal canal. Encysted dropsy is often 
beyond the resources of art, especially if its situation does 
not permit the evacuation of the fluid, but should this be 
practicable, a cure may be obtained. 

SCORBUTUS. 

This disease is characterized by a remarkable fluidity 
of the blood, which is readily effused into the aubcutane- 



308 THE PHYSIOLOGICAL 

ous cellular tissue, and produces livid spots on the skin; 
by frequent haemorrhages, by vomiting, and by bleeding 
of the gums. 

Symptoms. 

General lassitude, aversion to motion, prostration of 
strength, pale and bloated face, tendency to syncope, oc- 
casioned by the least movement, palpitation of the heart, 
and wandering pains in the muscles, are the first symp- 
toms that point out the disease; the gums are livid and 
spongy, they permit the escape of a very thin blood, and 
become ulcerated; the teeth become denuded and loose, 
the breath is intolerably fetid; the skin is at first dry and 
harsh to the touch, but in a short time large livid blotches 
as well as fetid ulcers appear on different parts of it, and 
particularly on the lower extremities; if the disease has 
deeply tainted the system, haemorrhages occur from dif- 
ferent parts of the body, from the mucous membranes of 
the mouth, the nose, the vagina, the intestinal canal, and 
sometimes even from the ends of the fingers; the blood 
poured forth in the haemorrhages is to a great extent de- 
prived of its fibrine, and does not coagulate. There is 
generally obstinate constipation throughout the disease, 
sometimes the contrary is the case, and we observe a 
diarrhoea attended with flatulency. 

Cold and dampness, want of vegetable food scarcity, of 
provisions, and dejection of spirits, are, when united, the 
causes which generally produce the scurvy. It does not ap- 
pear that any of these causes separately can produce the dis- 
ease. The exclusive use of salt provisions contributes to 
its production, but experience proves that it cannot alone 
give rise to it. 

The proximate cause, or rather the nature of scurvy, 
consists in a relaxation of all the tissues, and in an altered 
state of the blood, which becomes more serous and less 



PRACTICE OF MEDICINE. 309 

rich in fibrine. Among modern physicians, there are some 
who regard this alteration of the blood as primitive, or, 
as they say, essential; others make it depend on a morbid 
state of the solids; we coincide in opinion with the latter, 
for reasons which it would occupy us too long to state in 
this work. This disease is, at the present time, of very 
rare occurrence. 

Prognosis. 

The progress of this disease is either rapid or slow, 
which has occasioned its division into acute and chronic; 
its duration is indefinite; its termination may be favoura- 
ble, but in this case convalescence is generally slow. 

Treatment. 

In the first place, the removal of the occasional causes; 
food consisting of vegetables, fruits, and fresh meat; aci- 
dulated drinks, and particularly lemonade; the use of beer 
made with hops; the martial preparations. Very favour- 
able results have been obtained from the employment of the 
vegetable astringents, and particularly from a mixture of 
equal parts of lemonade and the decoction of rhatany; 
oak-bark, bistort, tormentil, the root of the pomegranate, 
would, without doubt, produce the same effects. These 
various astringents act with sufficient promptness in ar- 
resting the haemorrhages, whether subcutaneous or from 
the mucous membranes. 

The ulcers of the mouth should be washed with the 
decoction of mallows, and afterwards one of the preced- 
ing decoctions may be used; constipation may be obviated 
by means of emollient lavements; Ihe patient must respire 
a pure air in a dry and temperate atmosphere. 

What shall we say of the antiscorbutics? We read in 
the annals of science, that the crew of a ship, suffering 
40 



310 THE PHYSIOLOGICAL 

with scurvy, put into a northern island, and there eat 
largely of cresses, and were cured. But in that island 
this plant is mild, and not acrid, as in our climate, and 
those of a more southern latitude; it therefore had the 
common effect of fresh and mild vegetables. In our cli- 
mate, the so called antiscorbutics are rather hurtful than 
beneficial in scurvy. This disease, although its nature is 
not well defined, particularly forbids blood-letting. 

SYPHILIS. 

Symptoms. 

Syphilis, or the venereal disease, is composed of symp- 
toms so numerous and varied, that it would be difficult to 
present a detailed account of them in a work like the pre- 
sent. All or most of the symptoms of syphilis, are rarely, 
perhaps never found united in one individual; one or a 
few are sufficient in the greatest number of cases to point 
out the existence of the malady. 

This disease is less violent in its ravages at the present 
day than it was at no very distant period, either owing to 
the rules of hygieine being better understood and acted 
upon, or to greater carefulness or a more rational treat- 
ment. Whatever may be the fact, the symptoms by which 
it is recognised are those which we are about to describe. 
There are primary symptoms which make their appear- 
ance upon the parts which have been in contact with the 
contagious matter; these are a flow of matter, chancres, 
mucous pustules, and but rarely vegetations on the sexual 
apparatus, sometimes buboes. 

When these affections, after having disappeared sponta- 
neously or owing to treatment, reappear, or are replaced 
at a later period by other phenomena, there results a se- 
ries of symptoms, to the group of which has been assign- 
ed the name of secondary syphilis. 



PRACTICE OP MEDICINE. 311 

The disease has further been divided into "simple con- 
secutive or secondary syphilis, and into constitutional sy- 
philis. The first appears in a short time after the disap- 
pearance of the symptoms of invasion. The second not 
until some months have elapsed. The symptoms of conse- 
cutive syphilis are ulcers, which reappear upon the sexual 
parts, others which supervene in the throat, on the lips, 
in the nasal fossae, sores between the folds of the inferior 
extremity of the rectum, on the hands, about the toes, in- 
guinal or axillary buboes, wet pustules on the margin of 
the anus, on the vulva, cutaneous pustules covered with 
scabs, and dry, or suppurating, of various form and as- 
pect, excrescences and vegetations on the parts of genera- 
tion, pains in the bones exasperated during the night, pe- 
riostosis, exostosis. These tumours, which are hard, more 
or less round, and painful upon pressure, are remarked 
particularly upon the bones that are but slightly covered 
by the soft parts, such are those of the cranium, the ster- 
num, the clavicles, the tibia, the cubitus; there afterwards 
supervene caries, necrosis, nodes, articular concretions, 
gummy tumours, violent head-aches, inflammation more 
or less acute of the conjunctiva and iris, sarcocele, alope- 
cia, the loss of the nails, laryngeal phthisis, and an infinite 
number of other irregular symptoms, which contribute to 
bring on debility, marasmus, and death. 

Causes. 

It is communicated by mediate or immediate contact to 
the genital parts, to the anus, to all the external openings 
of the mucous membranes, as well as to the skin deprived 
of the epidermis. Coition is the most usual means of its 
communication. 

Does there exist a virus sui generis, which infects the 
economy? As to the primary symptoms, it is certain that 
similar ones may be produced by a great number of irri- 



312 THE PHYSIOLOGICAL 

tating substances: thus, for example, by irritating the ca- 
nal of the urethra with a solution of ammonia, we may 
give rise to a gonorrhoea, to buboes, or to a sarcocele, and 
all the symptoms in this case are as though the disease 
had been produced by the contact of persons labouring 
under syphilis. In fact, the matter of gonorrhoea likewise 
developes sometimes a discharge from the urethra, some- 
times a chancre, and sometimes a bubo, as numerous and 
incontestible observations demonstrate. Without pre- 
judging the question yet under litigation of the existence 
of the syphilitic virus, we may assert the following pro- 
positions as settled: first, the primitive symptoms of the 
venereal affection may be produced by other irritants be- 
sides the matter of infection; second, the secondary symp- 
toms are very often the effect of the treatment, and parti- 
cularly of the administration of mercury. We can indeed 
produce at pleasure all the symptoms of constitutional sy- 
philis, by means of the mercurial preparations, in animals 
and individuals who have not exposed themselves to con- 
tract it; third, that the cures obtained by sudorifics are, 
in a great number of cases, the result of the relinquishment 
of the mercurial treatment, for which these substances 
and the antiphlogistic regimen have been substituted; the 
cures operated by the preparations of gold and other re- 
medies, where mercury had failed, are also due in all 
probability to the abandonment of the last metal; fourth, 
that complete and permanent cures of the primitive affec- 
tion can be obtained by a well-directed antiphlogistic treat- 
ment, and that consecutive syphilis is often cured by this 
same treatment, either alone, or conjoined with a mild 
temperature and sudorifics. 

Notwithstanding these observations, it is certain, on the 
other hand, that the mercurial preparations are efficacious 
in a great number of cases, provided they be not abused. 
But to explain the effects of this agent, it is not necessary 



PRACTICE OP MEDICINE. 313 

to suppose the existence of a virus which it destroys; it 
is sufficient to admit that it modifies, in an advantageous 
manner, the abnormal action of the diseased tissues, since 
it likewise produces happy effects in various glandular 
engorgements, in certain affections of the skin, of the cel- 
lular membrane, &c. where there is no suspicion of a 
virus. 

Treatment. 
If we have to treat only a discharge from the urethra, 
recent or ancient, or a swelled testicle, or, as it is vulgarly 
named, the venereal testicle, we are to follow the precepts 
laid down in the sections upon irritations of the genital 
apparatus of man. Recent bubo should be treated like 
every other phlegmonous inflammation, that is, vigorously 
from the commencement, by local bleeding, more or less 
frequently repeated, rather copious than otherwise, by 
emollient cataplasms, and the long-continued application 
of ice, if the subject is cobust, and not of an irritable con- 
stitution, complete rest, and abstinence, or a very light 
regimen. These means generally succeed in producing a 
resolution of the inflammation, but if, notwithstanding 
this treatment, the tumour suppurates, we let out the pus 
early, and afterwards dress it as we would any simple ul- 
cer. It has been proposed to destroy at once, at their 
commencement, the chancres which make their appear- 
ance upon the gland and the penis in men, and the labia 
pudendi in women, by the ectrotic method, which con- 
sists in cauterizing, with the nitrate of silver, the kind of 
vesicular elevation, which precedes the solution of conti- 
nuity, called chancre; even the latter may be treated in 
the same manner if it does not occupy too great an ex- 
tent; in every case it is proper to use local and general 
warm bathing, demulcent and slightly sudorific drinks, 
and sometimes topical mercurial applications. 



314 ' THE PHYSIOLOGICAL 

If the disease is inveterate and constitutional, it should 
be inquired whether the patient has used mercury to ex- 
cess, and should this be the case, it will generally suffice 
to leave it off and replace it by sudorific drinks, such as 
the decoctions of sarsaparilla and guaiacum, for the pur- 
pose of gradually eradicating the disease. If the mercu- 
rial preparations have not been abused, they may be asso- 
ciated with the preceding decoctions; the deuto-chloride 
of mercury is the preparation preferred by nearly all 
physicians as being the most commodious and the most 
active. The dose is about a quarter of a grain, morning 
and evening, usually dissolved in distilled water. The 
mean duration of this treatment is from forty to sixty 
days; it must be suspended if there arise any disagreeable 
symptoms in the alimentary canal. Warm bathing, that 
of the thermal waters, and a warm atmosphere are of great 
service in the treatment of this disease, by increasing the 
action of the skin. Cold on the other hand obstructs the 
cure; it is on this account that the disease is more obsti- 
nate in northern than in southern latitudes. 

There is in Guinea and in many parts of America, a 
disease called the plan or yarws, which attacks the ne- 
groes principally; it appears to have much analogy with 
syphilis, and is probably only a variety of it. It requires 
the same treatment as syphilis. 

INTESTINAL WORMS. 

The intestinal canal sometimes becomes the habitation 
of different species of worms, the presence of which pro- 
duces such a diversity of symptoms that it would be very 
difficult to enumerate them all. The local irritation which 
they determine in the intestinal canal, may produce colics 
more or less violent, convulsions, aphonia, attacks of epi- 
lepsy, hysteria, nymphomania, satyriasis, diarrhoea, vo- 



PRACTICE OF MEDICINE. 315 

miting, disgust for food, voracious appetite, fever, &c. 
All these different phenomena are in proportion to the ir- 
ritability of the patient, varying with age, temperament, 
constitution, &c. Every other irritation of the intestinal 
canal produces effects very similar to these, giving rise to 
few secondary or sympathetic phenomena in indolent and 
lymphatic constitutions, but on the contrary, developing 
many in nervous and irritable subjects, who are of a thin 
habit. To speak correctly then, there are no really pa- 
thognomonic signs of the presence of worms in the alimen- 
tary canal, except the evacuation of them whole, or in 
fragments, by stool or by vomiting. Nevertheless, be- 
side this symptom, which removes all uncertainty, there 
are many which, when they occur together, may, to a 
certain extent, indicate their presence. These symptoms 
are the following: — 

Dilatation of the pupils, dimness of sight, livid circles 
round the eye, itchiness of the alas nasi, livid tint, grind- 
ing of the teeth, agitation during sleep, tingling of the 
ears, sour breath, disgust for food, a voracious appetite, 
hiccup, salivation, nausea, vomiting of acid matters, bor- 
borygmus, colics, diarrhoea, tenesmus, sometimes tumefac- 
tion of the abdomen, deliquium, subsultus tendinum, and 
involuntary movements, horripilation, sometimes a pene- 
trating or a dull pain in some point of the intestinal canal, 
a feeling of relief and comfort after the expulsion of one 
or more worms, in some cases emaciation. To this series 
of symptoms are added the sympathetic phenomena enu- 
merated above. 

Besides these general symptoms common to all species 
of worms, authors mention some which are peculiar to 
each kind, but itchiness at the anus considered as sympto- 
matic of the aacarideSj the pungent pain and sensation of 
creeping in the intestines attributed particularly to the 
lumbrici, the sensation of something revolving in the in- 



316 THE PHYSIOLOGICAL 

testifies, the undulation of the abdomen, and the vora- 
cious appetite said to be pathognomonic signs of taenia; 
these symptoms, we say, are not peculiar, and may be de- 
termined by all the species of entozoaria, and, we repeat 
it, there are no pathognomonic signs of worms in general 
and of their species in particular, except their expulsion 
in the alvine discharges, or by vomiting. 

The Ascaris vermicularis is fusiform, from three to 
nine lines in length, with an obtuse head, and terminating 
in a very fine and transparent tail. The Jlscaris lumbri- 
coidis resembles closely the earth-worm in its form and 
size, which varies from three or four inches to ten or 
twelve; its colour is whitish. It is impossible that the 
taenia should be confounded with any other intestinal 
worm, on account of its length, which is sometimes asto- 
nishing, and may extend from eighty to one hundred feet. 
Two species of them have been distinguished: the Taenia 
armata, or the Taenia solium, or Taenia a long an- 
neaux of Cuvier; and the Taenia non armata, or Taenia 
lata or vulgaris. The diameter of the body of the first 
varies much, according to the point at which it is examin- 
ed; towards the head it is about a quarter or a third of a 
line, but it augments progressively to three, four, or even 
six lines. It may also vary much in thickness, and some- 
times it is even sufficiently thin to become transparent. 
The articulations of this taenia, detached from each other 
by any accident, and passed in the alvine dejections, have 
given rise to the name cucurbitinus. The Taenia ar- 
mata is uncommon in France, but sufficiently common in 
other parts of Europe. The Taenia lata is flat, thin, 
whitish, or of a clear gray. Its head is elongated, and 
divested of the crown of holders which surrounds the 
mouth of the preceding species. It attains nearly the 
same length as the preceding, but its breadth is sometimes 
nine or ten lines or even an inch. This species is found 



PRACTICE OP MEDICINE. 317 

very frequently in France, Switzerland, Russia, and Po- 
land. Although more difficult to destroy, this species 
occasions less pain than the Taenia solium. 

The Taenia armata and the non armata are never 
found in the same persons; but notwithstanding its com- 
mon name of the solitary worm, we sometimes find two, 
sometimes three, and even a greater number of the same 
species. 

Their mode of development in the human body is little 
known. They are observed at all periods of life; the as- 
carides, however, torment infants more particularly, and 
those especially of a lymphatic constitution; the lum- 
bricus and taenia is generally met with in adults, and par- 
ticularly in persons of an indolent, lymphatic tempera- 
ment, in those whose constitutions are debilitated or 
broken down by long disease, in the poor who are badly 
fed, and oftener in females than in males. 

Treatment. 
Should there exist an intestinal phlegmasia, we first en- 
deavour to cure this affection, or others which might con- 
tra-indicate the administration of anthelmintics, all of 
which are irritants to a greater or less extent. (See Ver- 
minous Fever.) To effect the expulsion of the ascarides 
and lumbrici, the following anthelmintics are generally 
employed: the helminthorton, in a decoction made with 
from two drachms to an ounce in two or three glasses of 
water; the artemesia judaica taken in powder, in doses 
varying from twenty grains to a drachm, or in an infusion 
with from two to four ounces to a pint of water; two or 
three drachms of the artemesia judaica, incorporated with 
honey or sweetmeats, and given in several doses, is the 
remedy most resorted to in the case of infants, and scl 
dom fails; the sandal wood administered in the same man- 
ner, and in the same proportions; the proto-chloride of 
41 



318 THE PHYSIOLOGICAL 

mercury, from four to ten grains, divided into several 
doses. We may likewise use St. John's wort, the coral- 
lina officinalis, tin, the mulberry tree, garlic, the peach 
tree, tansy, castor oil, southern wood, wormwood, &c. 
But these vermifuge medicines succeed but very rarely 
against the taenia; we must always in this case employ the 
most powerful remedies of this class. Many species of 
anthelmintics have been recommended; the selection, the 
quantity, and time of administering them, must be regu- 
lated by the degree of local irritations, and by the sympa- 
thetic lesions. We shall pass over the numerous prepa- 
rations cried up as remedies in different periods, and by 
different physicians, and be content to point out the treat- 
ment generally adopted at the present day. 

Bark of the Pomegranate tree. — The fresh bark of 
the root of this tree is employed in decoction, made with 
one or two ounces for three or four glasses of water. The 
worm is generally voided after the second glass, some- 
times after the first. 

The Male fern. — This is administered in many ways. 
M. Bourdier gave in the morning a glass of a strong de- 
coction of this substance, with the addition of a drachm 
of sulphuric ether, (the quantity of ether is much too 
great, and should be reduced to one-half;) an hour after, 
he prescribed one or two ounces of castor oil; he repeated 
this treatment the next day, or two days after, if the first 
dose proved unavailing. 

M. Alibert prescribes the following decoction, to be 
taken by the glass at dinner, and for the ordinary drink: 
— Root of the male fern, four drachms; water three pints, 
boiled down to two; add syrup of coralline, two ounces. 
Three hours after the meal, three or four grains of calo- 
mel incorporated with conserve of roses are administered. 
On the ensuing day the following purgative is prescribed: 
— Scammony in powder, eighteen grains; root of the male 



PRACTICE OF MEDICINE. 319 

fern pulverized, one drachm; gamboge and calomel, of 
each, twelve grains; to be taken in three doses. The re- 
medy should be modified by a consideration of the age of 
the patient, and particularly the state of the intestinal 
canal. 

The remedy of Madame Nouffler consists in giving 
some panada to the patient in the evening, and the next 
morning administering three drachms of the pulverized 
root of the male fern in a decoction of the same. Two 
hours afterwards a purgative bolus is administered, com- 
posed of ten grains of calomel and scammony, and six 
grains of gamboge, incorporated with confection of hya- 
cynths. This purgative is evidently too irritating, and if 
the taenia be expelled, it is at the expense of the mucous 
membrane of the intestines. Fresh castor oil is advanta- 
geously substituted for it. The treatment employed 
against taenia being always very irritating, it is expedient 
to put those who have been subjected to it on mucilagi- 
nous drinks and a mild and vegetable regimen during a 
few days subsequently to its administration. 



THE END. 



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